Remote Lead Coding Auditor, Itemized Billing & Appeals

Gainwell Technologies; Town of Texas, Northern (WI, KY); Hybrid; USD 78,000 - 88,000; Full time

Benefits offered by this job

Benefits from day one

401(k) employer match

Educational assistance

Job summary

Gainwell Technologies seeks a Lead Coding Auditor for Itemized Bill Review and Appeals. This 100% remote role requires expertise in inpatient hospital bill auditing, outpatient facility coding, and charge master review.

You will train Coding Auditors, participate in hearings, and ensure billing is accurate and compliant with plan policies. As part of the mission, you will analyze documentation, maintain coding knowledge, and support management with production and quality goals while working

Qualifications

• Credentials through AHIMA or AAPC required and maintained.
• 3+ years inpatient hospital bill auditing and outpatient facility coding.
• Experience with appeals and hearings process.
• Excellent written communication for appeal determinations.
• Excellent oral communication for case summaries and decisions.
• Ability to multi-task in a fast-paced production environment.
• Proficient in ICD-10-CM/PCS, CPT/HCPCS, HCPCS and CPT coding methodology.
• Strong knowledge of hospital billing/charging including UB-04s and revenue codes.

Responsibilities

• Verify itemized bill accuracy reflecting services performed, covered benefits, proper ordering, documentation, and reimbursement per plan terms.
• Evaluate documentation for accurate coding and reimbursement for inpatient and outpatient services.
• Utilize auditing systems to document findings and rationale.
• Review appeals and redeterminations using guidelines and document decisions clearly.
• Analyze appeal documentation to ensure all aspects are addressed while meeting production goals.
• Prepare case files and summaries for hearings; participate virtually or on-site.
• Maintain productivity and quality standards as set by management.
• Cross-train to review multiple claim types to meet client needs.
• Assist management with training new Coding Auditors; provide mentoring and education.
• Keep current knowledge of coding guidelines and complete CEUs for certification.
• Attend training and meetings to enhance skills and knowledge.

Skills

AHIMA/AAPC credentials

Inpatient/outpatient auditing

Appeals process knowledge

Strong writing skills

Strong verbal communication

multitasking

Medical coding proficiency

UB-04 / revenue codes knowledge

Job description

Gainwell Technologies seeks a Lead Coding Auditor for Itemized Bill Review and Appeals. This 100% remote role requires expertise in inpatient hospital bill auditing, outpatient facility coding, and charge master review.

You will train Coding Auditors, participate in hearings, and ensure billing is accurate and compliant with plan policies. As part of the mission, you will analyze documentation, maintain coding knowledge, and support management with production and quality goals while working