This is a remote position.
Certified Medical Coder/Medical Record Audit Specialist
We are seeking a detail-oriented Certified Medical Coder / Medical Record Audit Specialist to support coding accuracy, medical record review, and billing compliance activities for Indiana Medicaid programs. This role is responsible for reviewing medical records and claims-related documentation for coding accuracy, identifying billing and compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings strong coding knowledge, regulatory awareness, and analytical and writing skills. This is a remote position with occasional travel required within Indiana.
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.
• 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.
Qualifications
• 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.
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