Medical Record Audit Specialist

About the role

We are seeking a Certified Medical Coder/Medical Record Audit Specialist with strong Behavioral Health coding experience to support a state Medicaid program engagement. This fully remote position focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issues, and preparing audit work-papers and reports in alignment with CMS, AHIMA, and Indiana Medicaid standards. Occasional travel to Downtown Indianapolis, IN is required (expenses covered).

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 work-papers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
• Assist with 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

Required Qualifications:

• Active coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC).
• Minimum 2-3 years of hands-on medical coding, claims review, or audit experience.
• Significant experience coding Behavioral Health, Mental Health, or Psychiatric encounters.
• Hands-on proficiency with ICD-10-CM, CPT, and HCPCS coding systems.
• Experience conducting medical record audits, claims reviews, or supporting appeals.
• Comfortable completing a timed Excel proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the client prior to submission.

Preferred Qualifications:

• Familiarity with Indiana Medicaid (IHCP) policies and payer guidelines.
• Knowledge of CMS regulations and AHIMA Standards of Ethical Coding.
• Experience with Epic, Cerner, 3M Encoder, or similar EHR and encoder platforms.
• Prior experience specifically supporting Medicaid audit or compliance functions.