Medical Coder - Audit Specialist

Key Responsibilities

• Review medical records and related documentation to assess coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
• Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer.
• Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.
• Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
• Audit responses and appeals as needed.
• Ensure all work aligns with state, federal, and national coding and reimbursement guidelines.
• Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates.
• Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.

Requirements

• Coding certification such as CCS, CPC, or CPMA required.
• At least 1 year of medical coding, claims review, billing compliance, or related healthcare reimbursement experience.
• Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred.
• Candidate located in or near the Indianapolis area preferred.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Strong analytical, critical thinking, problem-solving, and technical writing skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience working with healthcare providers strongly preferred.
• Knowledge of healthcare claims data and fraud, waste, and abuse preferred.

Physical Requirements & Environmental Conditions

• An employee must meet these physical demands to successfully perform the essential functions of this job.
• Employee is regularly required to talk or hear, sit, and utilize technology tools such as a laptop computer for extended periods of time.
• Specific vision abilities include close vision and the ability to adjust focus.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.