Coding Auditor
Healthcare Fraud Shield
Salary undisclosed
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Description
Key Responsibilities
- Compare the procedures and codes billed on a claim to a medical record.
- Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
- Determines appropriateness of billing and reimbursement as needed.
- Documents findings for each claim line in a spreadsheet as needed.
- Summarize findings in a written report as needed.
- Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
- Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
- Understands and complies with all company Privacy and Security standards.
- Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
- On average, there are a minimum of 5-10 claim line reviews per hour.
- Other duties as needed.
Skills, Knowledge and Expertise
- Knowledge of medical terminology.
- Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
- Knowledge of specialty medical practices.
- Must be detail oriented.
- Ability to communicate effectively both verbally and in writing.
- Strong listening skills.
- Independent.
- Responsible.
- Self-disciplined.
- Ability to meet defined performance and production goals.
- Strong computer skills.
- This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Certificate/License:
- Minimum of one year of investigative experience is required.
- Required to have one of the following: CPC, CCS, CCA
Benefits
- Medical, Dental & Vision insurance
- 401(k) retirement savings with employer match
- Vacation and sick paid time off
- 7 paid holidays & 2 floating holidays
- Paid maternity/paternity leave
- Disability & Life insurance
- Flexible Spending Account (FSA)
- Employee Assistance Program (EAP)
- Professional and career development initiatives
- Remote work eligible
- Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
Benefits
- Medical, Dental & Vision insurance 401(k) retirement savings with employer match Vacation and sick paid time off 7 paid holidays & 2 floating holidays Paid maternity/paternity leave Disability & Life insurance Flexible Spending Account (FSA) Employee Assistance Program (EAP) Professional and career development initiatives Remote work eligible REMOTE WORK REQUIREMENTS: Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload. Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
About this role
Healthcare Fraud Shield is hiring a Coding Auditor to review medical claims and ensure accurate billing alignment between healthcare records and submitted codes. Working remotely from Kentucky headquarters, you'll spend your days comparing procedures documented in patient records against billed ICD-10-CM, CPT, HCPCS, and Revenue codes, then documenting discrepancies and summarizing findings in reports. The role demands consistent output—roughly 5 to 10 claim line reviews per hour—and requires meticulous attention to detail, strong computer proficiency, and the ability to work independently while staying current with coding guidelines and federal and state regulations.
This position is designed for someone with a certified coding credential (CPC, CCS, or CCA) and at least one year of investigative experience. You'll need solid knowledge of medical terminology, specialty practices, and the full range of coding systems, along with the discipline to handle confidential health information responsibly. The work is straightforward but demanding: abstract codes from records, verify billing appropriateness, and document your findings clearly for the Special Investigations Unit management team overseeing your work.
The company offers a standard benefits package including medical, dental, and vision coverage, 401(k) matching, paid time off, and professional development support. You'll need high-speed internet (minimum 25 Mbps download, 5 Mbps upload) to work remotely in this role.
How this employer is doing
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Pay for this role
The employer didn't post a pay range for this role. That usually means pay is set in negotiation, which favors whoever arrives with numbers. Check ranges on comparable Coding Auditor postings in Headquarters, and analyze any offer before you accept it.
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