Coding Auditor

🔥 6 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

🔎 Auditor

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Healthcare Fraud Shield

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

💰 Private Equity Round on 2021-01

Healthcare Insurance • Artificial Intelligence • Fraud Prevention

Healthcare Fraud Shield is a company specializing in Payment Integrity and Cost Containment solutions for healthcare insurers. They offer a comprehensive, AI-driven platform that incorporates advanced anomaly detection and a proprietary data fusion library to combat fraud, waste, abuse, and errors in healthcare claims. Their robust end-to-end solution optimizes the auditing process, utilizing both pre- and post-payment data to maximize savings and improve accuracy in claim processing. By providing actionable insights and expert support, Healthcare Fraud Shield helps organizations achieve significant annual savings and enhance operational efficiency.

📋 Description

• 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.

🎯 Requirements

• Minimum of one year of investigative experience is required. • Required to have one of the following: CPC, CCS, CCA • 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.

🏖️ 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