Medical Auditor

🔥 13 minutes ago

🇺🇸 United States – Remote

💵 $36 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Sprinter Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2021

🏥 Healthcare

☁️ SaaS

🧘 Wellness

💰 $33M Series A on 2021-11

Healthcare • SaaS • Wellness

Sprinter Health is a hybrid in-home and virtual primary care provider that expands access to proactive, preventive healthcare by combining community-based, W-2 “Sprinters” (trained phlebotomists with medical assistant and community health worker skills) who perform hands-on diagnostics and wellness checks in patients’ homes with a virtual clinical team of physicians, nurses, pharmacists, and care navigators. Their full-stack platform and operations close care gaps, deliver preventive screenings and diagnostics, coordinate medications and referrals, and scale longitudinal primary care and wellness visits for payer and provider partners and patients.

📋 Description

• Conduct routine and focused audits of medical coding to ensure compliance with CMS, payer, and organizational standards. • Develop and deliver education and feedback to coders and providers to improve documentation quality and coding accuracy. • Assist with internal and external audit preparation and response, including documentation requests and validation reviews. • Maintain audit tracking logs, productivity reports, and accuracy metrics in accordance with company policies. • Review medical records, claims data, and provider documentation to assess the accuracy of ICD-10-CM, CPT, HCPCS, and modifier assignment. • Identify coding errors, trends, and opportunities for improvement; prepare detailed audit reports with actionable findings. • Develop and deliver education and feedback to coders and providers to improve documentation quality and coding accuracy. • Assist with internal and external audit preparation and response, including documentation requests and validation reviews. • Maintain audit tracking logs, productivity reports, and accuracy metrics in accordance with company policies. • Stay current with AAPC, AHIMA, CMS, and OIG guidelines, as well as payer policy changes and HCC model updates. • Uphold all HIPAA, privacy, and compliance standards in handling patient data and audit documentation.

🎯 Requirements

• Certification: Active AAPC (CPC) or AHIMA (CCS-P, CCS) certification. • Experience: Minimum 3 years of medical coding experience, with at least 1-2 years in a coding audit, QA, or compliance capacity. • Strong understanding of HCC / risk adjustment coding principles, clinical documentation improvement, and coding validation practices. • Excellent command of medical terminology, anatomy, physiology, pathophysiology, disease progression, and pharmacology. • Deep familiarity with CPT, ICD-10-CM, HCPCS, and modifier assignment. • Ability to work independently and maintain productivity in a remote setting. • Strong communication and problem-solving skills. • Proficient in EHR systems, encoder/coding software, and Google tools. • Reliable internet connection and dedicated, secure workspace.

🏖️ Benefits

• 100% paid health, dental, vision premiums (for families too) • Generous parental leave (4 months for birthing parent, 2 months for partners) • 401(k) with company match • Unlimited PTO + flexible schedule