Remote Facility Coding Auditor & Claims Quality Analyst

NACBA; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401K with company match

Tuition reimbursement

Holidays

Flexible PTO

Life Insurance

Job summary

NACBA is seeking a remote Claims Audit Specialist to support the Director of Health Information Management by auditing hospital outpatient and ProFee claims for coding accuracy, revenue integrity, and billing compliance. You will leverage proprietary software to develop client reports and present findings to leadership, ensuring high-quality reimbursement outcomes.

Ideal candidates have 5+ years of hospital outpatient coding audit experience, AHIMA or AAPC certification (CPC-A not accepted), and

Qualifications

• AHIMA or AAPC certification required (CPC-A not accepted).
• Minimum 5 years of hospital outpatient facility coding audit experience.
• Expertise in ED, SDS, OBS, I&I, E/M and ancillary outpatient services.
• Experience presenting findings to healthcare clients and leadership teams.
• Strong written and verbal communication skills.

Responsibilities

• Perform detailed audits of hospital outpatient and ProFee claims to identify coding, billing, charging, and revenue cycle improvement opportunities.
• Review and recommend coding, charge capture, revenue integrity, and claim optimization strategies.
• Utilize proprietary software to analyze audit findings and develop standardized client reports.
• Present audit results and recommendations to clients in a clear, professional manner.
• Respond to coding and compliance-related inquiries with concise, grammatically correct written and verbal communication.
• Collaborate with revenue cycle consultants, coding professionals, and client stakeholders to support project goals.
• Develop educational materials, FAQs, and client-facing guidance on coding and billing best practices.
• Assist with special projects and other duties as assigned.

Skills

Audit reporting

Written & verbal communication

Revenue cycle knowledge

Coding compliance

Healthcare billing

Education

AHIMA/AAPC certification (CPC-A not accepted)

Tools

Proprietary audits software

Job description

NACBA is seeking a remote Claims Audit Specialist to support the Director of Health Information Management by auditing hospital outpatient and ProFee claims for coding accuracy, revenue integrity, and billing compliance. You will leverage proprietary software to develop client reports and present findings to leadership, ensuring high-quality reimbursement outcomes.

Ideal candidates have 5+ years of hospital outpatient coding audit experience, AHIMA or AAPC certification (CPC-A not accepted), and