Medical Record Audit Specialist

Zoho; Indianapolis (IN); Remote; USD 70,000 - 90,000; Full time

Job summary

RADcube - A NLogix Company seeks a Certified Medical Coder/Medical Record Audit Specialist with Behavioral Health coding expertise for a fully remote role. You will audit records and claims, ensure coding accuracy and compliance, and prepare work-papers and reports aligned with CMS, AHIMA, and Indiana Medicaid standards.

This role requires 2–3 years of hands-on coding and audits, CCS/CPC/CPMA certification, and proficiency with ICD-10-CM, CPT, and HCPCS.

Qualifications

• Active coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC).
• 2–3 years hands-on medical coding, claims review, or audit experience.
• Significant experience coding Behavioral Health, Mental Health, or Psychiatric encounters.
• Proficient with ICD-10-CM, CPT, and HCPCS coding systems.
• Experience auditing medical records, claims reviews, or supporting appeals.
• Excel proficiency assessment may be required by client.

Responsibilities

• Review medical records and related documentation to assess coding accuracy and compliance with applicable standards.
• Conduct coding and documentation reviews independently and provide preliminary findings.
• Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.
• Maintain detailed work-papers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
• Assist with audit responses and appeals as needed.
• Ensure all work aligns with state, federal, and national coding guidelines and reimbursement policies.
• Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines and updates.
• Research Indiana Medicaid rules and maintain internal repositories of bulletins and procedures.

Skills

Behavioral Health coding

Coding audits

Documentation reviews

Excel proficiency

Tools

Epic EMR

Cerner EMR

3M Encoder

Job description

Job Description

This is a remote position.

Certified Medical Coder/Medical Record Audit Specialist - Behavioral Health

Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)

Job Summary:

We are seeking a Certified Medical Coder/Medical Record Audit Specialist with strong Behavioral Health coding experience to support a state Medicaid program engagement. This role focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issues, and preparing audit work-papers and reports in alignment with CMS, AHIMA, and Indiana Medicaid standards.

Key Responsibilities

• Reviewmedicalrecords and related documentation to assess coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.


• Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer.


• Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.


• Maintain detailed work-papers documenting procedures performed, records reviewed, findings identified, and conclusions reached.


• Assist with audit responses and appeals as needed.


• Ensure all work aligns with state, federal, and national coding and reimbursement guidelines.


• Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates.


• Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.


• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.

Requirements

Required Qualifications:

• Active coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC).


• Minimum 2-3 years of hands-on medical coding, claims review, or audit experience


• Significant experience coding Behavioral Health, Mental Health, or Psychiatric encounters


• Hands-on proficiency with ICD-10-CM, CPT, and HCPCS coding systems


• Experience conducting medical record audits, claims reviews, or supporting appeals


• Comfortable completing a timed Excel proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the client prior to submission

Preferred Qualifications

• Familiarity with Indiana Medicaid (IHCP) policies and payer guidelines


• Knowledge of CMS regulations and AHIMA Standards of Ethical Coding


• Experience with Epic, Cerner, 3M Encoder, or similar EHR and encoder platforms


• Prior experience specifically supporting Medicaid audit or compliance functions.