Senior Healthcare Coding & Audit Consultant

Stout; Detroit (MI); On-site; USD 74,000 - 135,000; Full time

Job summary

Stout seeks an experienced healthcare reimbursement professional to join our team, focusing on complex coding, billing audits, and regulatory compliance. This role spans inpatient, outpatient, ASC, and professional services, requiring deep knowledge of CMS rules, HIPAA, and fraud prevention.

Expect collaborative engagement with clients and legal teams, delivering defensible analyses and actionable recommendations.

Qualifications

• Bachelor's degree or equivalent in health information or related field.
• 5–10+ years of healthcare coding, billing, auditing, or revenue cycle experience.
• Hands-on experience with inpatient/outpatient/ASC and professional fee coding and reimbursement.
• Active HIM credentials preferred (e.g., CCS, CIC, CPC, COC, CPMA, CHCA/CHCAF, CPB, RHIT, RHIA).
• Advanced knowledge of coding guidelines, reimbursement methodologies, CMS/HIPAA/False Claims Act.
• Strong ability to analyze complex records, document methods, and communicate findings clearly.
• RN license or other clinical credential preferred.
• Leadership experience in HIM/compliance preferred.
• Health plan contracting/claims processing experience preferred.

Responsibilities

• Review medical records, policies, and contracts for accuracy, support, and compliance.
• Audit ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, modifiers, units, revenue codes across facilities and professionals.
• Evaluate MS-DRG, APR-DRG, APC, ASC, and professional fee reimbursement methodologies.
• Assess clinical documentation, medical necessity, level of care, utilization review, and coverage.
• Analyze end-to-end revenue cycle and claims lifecycle including denials and appeals.
• Review health plan contracts, reimbursement terms, and payment determinations.
• Plan risk-based audits, investigations, and forensic analyses; identify overpayments/underpayments.
• Develop clear workpapers, findings, and defendable conclusions.

Skills

Healthcare coding

Billing

Auditing

Revenue cycle

Payment integrity

Claims operations

Education

Bachelor's degree in Health Information Management or related field

Job description

Stout seeks an experienced healthcare reimbursement professional to join our team, focusing on complex coding, billing audits, and regulatory compliance. This role spans inpatient, outpatient, ASC, and professional services, requiring deep knowledge of CMS rules, HIPAA, and fraud prevention.

Expect collaborative engagement with clients and legal teams, delivering defensible analyses and actionable recommendations.