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 plan policies and provider contracts • Evaluate documentation for accurate coding, charging, and reimbursement of 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 determinations clearly and accurately while meeting production and quality standards • Prepare case files and summaries for hearings and participate in virtual or on-site hearings • Achieve productivity and quality performance 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 on clinical policies, procedures, rules, and regulations

🎯 Requirements

• At least one active professional credential through AHIMA or AAPC: CPC, COC, CCS, RHIA, or RHIT, maintained as a condition of employment • 3+ years of experience in inpatient hospital bill auditing and outpatient facility coding with charge master review • Working knowledge of appeals and hearings processes • Excellent written communication skills for clear, concise, accurate, fact-based appeal rationales • Excellent oral communication skills for presenting case summaries and decisions • Ability to multitask 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 and charging, including UB-04s, itemized bills, revenue codes, CPT/HCPCS codes, ICD-10 diagnosis and procedure codes • Proficiency with Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, Microsoft Teams, Zoom, and virtual meeting tools • Ability to travel up to 25% for on-site hearing testimony

🏖️ Benefits

• Benefits effective on your first day of employment • Clear career advancement opportunities with ongoing training and leadership development • Flexible work hours • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Work flexibility • Up to 25% travel for on-site hearing testimony