Medical Record Auditor

Blue Cross Blue Shield of Alabama; Birmingham (AL); On-site; USD 70,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Alabama is hiring a Medical Record Auditor to evaluate coded medical records and lead audits across internal and external coders. The role focuses on ensuring CMS guideline compliance and improving overall coding accuracy.

You will provide feedback, support policy development, and collaborate with clinical educators and networks to report coding quality. The position emphasizes strong attention to detail, CPC certification, and extensive knowledge of ICD-9/10, CPT,

Qualifications

• Bachelor's degree required or pursued; strong coding knowledge welcomed.
• 5 years of Certified Professional Coder (CPC) experience and project support experience.
• Knowledge of Medicare Advantage coding regulations.
• Extensive training in medical terminology, disease processes, and pharmacology.
• Proficiency with ICD-9/10, CPT, and CMS coding principles and guidelines; risk/HEDIS knowledge.
• Excellent written and verbal communication; highly detailed oriented.
• Experience with coding quality audits on medical records.

Responsibilities

• Lead audits of medical records for accuracy and CMS compliance.
• Score vendors, internal coders, and external coders on coding quality.
• Provide feedback to medical record coders and vendors; resolve coding questions with clinical teams.
• Assist with policy development and documentation of health risk assessments; respond to coding inquiries.

Skills

Attention to detail

Written and verbal communication

Microsoft Office proficiency

Education

Bachelor's Degree

Tools

Microsoft Office

CMS coding guidelines

Job description

The Quality and Value Based Care area strives to develop a "best in class" service model and experience for our senior population. Our team works closely with other associates and business areas that support Medicare Advantage members in an effort to meet and exceed customer expectations and continue driving toward strategic improvement.

Primary Responsibilities

The Medical Record Auditor is responsible for evaluating coded medical records completed by Medical Record Coders at Blue Cross and Blue Shield of Alabama, vendor coded medical records, and externally coded medical records by certified coders to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines. The primary responsibility of the Certified Medical Record Auditor is leading all audits of medical records and scoring vendors, internally coders, and external coders on accuracy along with quality of their coding. The Medical Record Auditor will be responsible for providing feedback to all medical record coders both internal and external along with any vendors. In addition to diagnosis code and CPT code validation, duties may include assisting with coding issues relating to policy development, documenting quality of medical records and health risk assessments, working with Clinical Nurse Educators and Health Care Networks to report coding accuracy by provider and responding to complex inquiries that require extensive coding knowledge. The Medical Record Auditor will act as the team lead for any coding related issues or questions both internally and externally.

Summary of Qualifications

• Bachelor's Degree; or upon hire commit to actively pursue Bachelor's degree
• 5 years of experience as a Certified Professional Coder (CPC) and proven experience in support of projects according to assigned responsibilities
• Demonstrated knowledge of Medicare Advantage regulations for coding
• Extensive training and knowledge of medical terminology, disease processes, and pharmacology
• Knowledge of Microsoft Office products
• Extensive knowledge of ICD-9/10, CPT, and CMS coding principles and guidelines, specifically Risk and HEDIS knowledge and experience
• Excellent written and verbal communication skills
• Strong attention to detail with excellent organizational skills
• Experience with coding quality audits on medical records
• Certified Professional Coder (CPC)
• Certified Coding Specialist for Providers (CCS-P), Certified Risk Coder (CRC) Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA)
• Broad understanding of Medicare guidelines, regulations and claims processing procedures preferred
• Experience in a position researching and validating coding criteria preferred

Work Location

The work schedule for this position will be full time remote. Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A remote work schedule is subject to amendment or termination at any time by the Company.

Terms and Agreements

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews. We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association

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