Coding Auditor

🔥 16 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

🔎 Auditor

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Healthcare Fraud Shield

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-01

Healthcare • Consulting • Healthcare Insurance

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

• Execute routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, and Revenue codes • Compare procedures and codes billed on claims to medical records • Compare claim information to determine the amount and nature of billable services • Determine appropriateness of billing and reimbursement • Document findings for each claim line in a spreadsheet • Summarize findings in written reports • Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records • Maintain current knowledge of coding guidelines and relevant federal and/or state regulations • Comply with company Privacy and Security standards • Protect confidential health information in accordance with applicable law • Complete a minimum average of 5–10 claim line reviews per hour • Perform other duties as needed

🎯 Requirements

• Certified professional coder • 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 • Ability to meet defined performance and production goals • Strong computer skills • Ongoing discretion and secure information management when accessing confidential and sensitive information • Must have high speed Internet; satellite is not allowed, with a minimum speed of 25mbs download and 5mbs upload

🏖️ 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