SIU Code Auditor — Healthcare Coding & Fraud Review

Fallon Health; Central Business District (MA); On-site; USD 74,000 - 101,000; Full time

Job summary

Fallon Health is seeking a SIU Code Auditor to conduct coding audits of medical records for E/M, DME, medical, home health, and possibly behavioral health services. The role supports fraud, waste, and abuse investigations and serves as a liaison between clinical and coding teams.

The position requires 3-4 years of relevant experience, CPC/CCS certification, and knowledge of ICD-10, CPT, HCPCS coding guidelines.

Qualifications

• Bachelor’s degree preferred or equivalent experience in healthcare.
• CPC and/or CCS required; CEMC or CPMA is a plus.

Responsibilities

• Review medical records and coding for ICD-10, CPT, HCPCS.
• Support investigations and communicate findings to stakeholders.
• Identify aberrant billing patterns and suggest improvements.
• Collaborate with providers and clinical teams to support accurate billing.
• Maintain documentation and assist with regulatory reporting and education.

Skills

Auditing

Medical coding

Regulatory compliance

Communication

Education

Bachelor’s degree or equivalent healthcare experience

CPC or CCS certification required

CEMC or CPMA a plus

Job description

Fallon Health is seeking a SIU Code Auditor to conduct coding audits of medical records for E/M, DME, medical, home health, and possibly behavioral health services. The role supports fraud, waste, and abuse investigations and serves as a liaison between clinical and coding teams.

The position requires 3-4 years of relevant experience, CPC/CCS certification, and knowledge of ICD-10, CPT, HCPCS coding guidelines.