We are seeking a detail-oriented Certified Medical Coder / Medical Record Audit Specialist to support coding accuracy, medical record review, and billing compliance activities for Indiana Medicaid programs. This role is responsible for reviewing medical records and claims-related documentation for coding accuracy, identifying billing and compliance issues, preparing audit documentation and reports, and supporting appeals activities.
This is a remote position with occasional travel required within Indiana.
Key responsibilities
- Review medical records and related documentation to assess coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
- Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer.
- Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.
- Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
- Assist with audit responses and appeals as needed.
- Ensure all work aligns with state, federal, and national coding and reimbursement guidelines.
- Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates.
- Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
- Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.
Requirements & Qualifications
Qualifications
- Coding certification such as CCS, CPC, or CPMA required.
- At least 1 year of medical coding, claims review, billing compliance, or related healthcare reimbursement experience.
- Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred.
- Candidate located in or near the Indianapolis area preferred.
- Proficiency in Microsoft Excel, Word, and Outlook.
- Strong analytical, critical thinking, problem-solving, and technical writing skills.
- Ability to work independently and collaboratively in a fast-paced environment.
- Experience working with healthcare providers strongly preferred.
- Knowledge of healthcare claims data and fraud, waste, and abuse preferred.
Location
Indianapolis, Indiana, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
4 weeks ago