医疗编码审计专员
Medical Coder Audit Specialist
热爱数据分析、解决谜题并确保准确性？Briljent 正在寻找一位注重细节的认证医疗编码师 - 审计专家，以帮助提高编码准确性、加强账单合规性，并支持印第安纳州医疗补助计划的完整性。
在这个职位中，你将运用你的编码专业知识、审计技能和高级 Microsoft Excel 知识，审查医疗记录，识别差异，分析索赔数据，并确保符合州和联邦法规。如果你喜欢调查工作、分析趋势，并将复杂发现转化为清晰报告，这个机会适合你。
这是一个远程职位，偶尔需要在印第安纳州内出差。强烈建议印第安纳州居民申请。
为什么你会喜欢这个职位
- 对服务于印第安纳州居民的医疗项目完整性产生有意义的影响。
- 运用你的分析和审计技能，发现结果并提高合规性。
- 利用高级 Microsoft Excel 能力来整理、分析和报告数据。
- 与经验丰富的医疗、合规和审计专业人员一起工作。
- 与不断变化的编码标准、法规和行业最佳实践保持同步。
你将负责的工作
执行编码审计与合规审查
- 审查医疗记录、索赔和相关文件，评估编码准确性和符合印第安纳州健康保险计划、CMS、AMA 及其他适用法规的情况。
- 独立进行详细的编码审计和文档审查。
- 识别编码差异、文档不足、账单异常和潜在合规问题。
- 保持完整的审计工作底稿，记录所执行的程序、审查的记录、发现的问题和得出的结论。
- 向审计领导汇报初步发现和建议。
分析数据并报告发现
- 使用 Microsoft Excel 整理、分析和验证审计结果和索赔数据。
- 为内部和外部利益相关者准备审计报告、摘要和支持文件。
- 识别可能表明账单错误、文档问题或流程改进机会的模式和趋势。
- 在需要时支持申诉审查和审计回应活动。
保持更新并支持持续改进
- 研究和解释印第安纳州医疗补助政策、公告和报销要求。
- 维护内部编码指南的资料库，以及相关的法规和标准。
查看英文原文
Love digging into data, solving puzzles, and ensuring accuracy? Briljent is seeking a detail-oriented Certified Medical Coder - Audit Specialist to help improve coding accuracy, strengthen billing compliance, and support the integrity of Indiana Medicaid programs.
In this role, you'll apply your coding expertise, auditing skills, and advanced Microsoft Excel knowledge to review medical records, identify discrepancies, analyze claims data, and help ensure compliance with state and federal regulations. If you enjoy investigative work, analyzing trends, and translating complex findings into clear reports, this opportunity is for you.
This is a remote position with occasional travel within Indiana. Indiana residents are strongly encouraged to apply.
Why You'll Love This Role
- Make a meaningful impact on the integrity of healthcare programs serving Hoosiers.
- Use your analytical and auditing skills to uncover findings and improve compliance.
- Leverage advanced Microsoft Excel capabilities to organize, analyze, and report data.
- Work alongside experienced healthcare, compliance, and auditing professionals.
- Stay engaged with evolving coding standards, regulations, and industry best practices.
What You'll Do
Conduct Coding Audits & Compliance Reviews
- Review medical records, claims, and supporting documentation to evaluate coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable regulations.
- Perform detailed coding audits and documentation reviews independently.
- Identify coding discrepancies, documentation deficiencies, billing irregularities, and potential compliance concerns.
- Maintain thorough audit workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
- Present preliminary findings and recommendations to audit leadership.
Analyze Data & Report Findings
- Utilize Microsoft Excel to organize, analyze, and validate audit results and claims data.
- Prepare audit reports, summaries, and supporting documentation for internal and external stakeholders.
- Identify patterns and trends that may indicate billing errors, documentation concerns, or opportunities for process improvement.
- Support appeal reviews and audit response activities as needed.
Stay Current & Support Continuous Improvement
- Research and interpret Indiana Medicaid policies, bulletins, and reimbursement requirements.
- Maintain internal repositories of coding guidance, regulatory updates, and audit resources.
- Stay current on CPT, HCPCS, ICD-10-CM, Medicaid coding guidance, and reimbursement methodologies.
- Adapt quickly to changing regulations, priorities, and audit requirements while maintaining accuracy and quality.
Requirements
What We're Looking For
Required Qualifications
· Current coding certification such as CCS, CPC, CPMA, or equivalent.
- Minimum of one (1) year of experience in medical coding, coding audits, billing compliance, claims review, healthcare reimbursement, or related auditing activities.
- Strong proficiency in Microsoft Excel, including data analysis, sorting/filtering, formulas, data validation, reporting, and working with large datasets.
- Strong analytical thinking, problem-solving, and technical writing skills.
- Ability to work independently while managing multiple priorities in a fast-paced environment.
Preferred Qualifications
· Additional certifications related to auditing, compliance, healthcare revenue cycle, or advanced Microsoft Excel are highly valued.
- Experience performing coding audits or healthcare compliance reviews.
- Knowledge of Indiana Medicaid policies, payer guidelines, and documentation requirements.
- Experience working directly with healthcare providers and clinical documentation.
- Knowledge of healthcare claims data analysis and fraud, waste, and abuse detection.
- Residence in or near the Indianapolis area.
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.
Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
Originally posted on Himalayas