Lead Coding Auditor, Itemized Bill Review and Appeals

🔥 13 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $78k - $88k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Perform itemized bill review, chart review, and coding validation • Verify billed services and procedures were performed, covered, ordered, documented, and reimbursed according to policies and provider contracts • Evaluate coding, charging, and reimbursement for inpatient hospital and outpatient facility services • Use proprietary auditing systems to document audit findings and rationale • Review appeals and redeterminations using approved clinical and coding guidelines • Analyze appeal documentation and document appeal determinations • Prepare case files and case summaries for hearings • Participate in virtual and on-site hearings • Achieve productivity and quality standards • Cross-train to review multiple claim types • Assist management with training, monitoring, mentoring, feedback, and education for new Coding Auditors • Maintain current coding guideline knowledge and complete required CEUs • Attend training and scheduled meetings

🎯 Requirements

• At least one active professional credential through AHIMA or AAPC: CPC, COC, CCS, RHIA, or RHIT; required and maintained as a condition of employment • 3+ years of experience in inpatient hospital bill auditing and outpatient facility coding with charge master review; strongly preferred • Working knowledge of the appeals and hearings process • Excellent written communication skills, including ability to write clear, concise, accurate, and fact-based rationales • Excellent oral communication skills for presenting case summaries and decisions • Ability to multi-task in a fast-paced production environment • Proficiency in medical record auditing and ICD-10-CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology • Strong knowledge of hospital billing/charging, including UB-04s, itemized bills, revenue codes, CPT/HCPCS codes, and ICD-10 diagnosis and procedure codes • Proficiency with Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, Microsoft Teams, Zoom, and similar virtual meeting tools

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Benefits effective on Day 1 • Clear career growth path • Training and leadership development opportunities • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Up to 25% travel for on-site hearing testimony