SIU Medical Auditor (CPC/CPMA) Remote

Overview

Join our dynamic team as a Remote SIU Medical Auditor (CPC/CPMA) and play a vital role in ensuring the integrity and accuracy of medical billing and coding processes. In this position, you will leverage your expertise to review complex medical records, analyze coding accuracy, and identify potential fraudulent or erroneous claims. Your keen eye for detail and comprehensive understanding of healthcare documentation will help maintain compliance standards and support the organization’s commitment to ethical billing practices. This remote opportunity offers flexibility, professional growth, and the chance to make a meaningful impact within the healthcare industry. Duties

• Conduct thorough audits of medical records, focusing on proper application of CPT (Current Procedural Terminology), ICD-9, ICD-10, and DRG (Diagnosis-Related Group) coding standards to ensure accurate billing.
• Review medical documentation for completeness, consistency, and compliance with federal and state regulations.
• Analyze coding accuracy by cross-referencing medical records with assigned codes such as ICD, CPT, and EHR (Electronic Health Record) data.
• Identify discrepancies or potential fraud in claims related to medical billing and collections, escalating issues as necessary.
• Collaborate with internal teams on QA processes and with the Special Investigations Unit (SIU) to provide coding expertise that directly impacts the efficiency of audits and legal reviews.
• Maintain detailed audit reports, documenting findings, recommendations, and corrective actions taken.
• Stay current with industry updates in medical coding standards, regulations, and best practices to ensure ongoing compliance.

Qualifications/Skills

• Certification: Active Medical Coding Certification (e.g., CPC, CPMA) is required.
• Note: Due to the complexity of this project, CPC-A (Apprentice) candidates will not be considered.
• Technical Skills: Mastery of medical terminology, anatomy, and various coding systems (CPT/HCPCS).
• Soft Skills: Ability to work independently in a remote setting, manage multiple tasks effectively, and maintain extreme attention to detail. Ability to analyze complex medical data efficiently while maintaining close attention to detail.

Excellent communication skills for collaborating with multidisciplinary teams and documenting audit findings clearly.

• Experience: Proven experience in medical coding and auditing within a payor environment and direct experience with Special Investigations Units (SIU) and Fraud, Waste, & Abuse (FWA) schemes. Specific experience auditing multi-disciplinary and behavioral health records is highly preferred. Strong knowledge of medical terminology, anatomy, and physiology to accurately interpret clinical documentation.

Proficiency in CPT coding, ICD-9/ICD-10 coding systems, DRG classifications, and EMR/EHR systems. Experience with medical billing processes, collections, and healthcare reimbursement methodologies. Familiarity with medical records management and the review process for ensuring compliance with healthcare regulations. Prior experience in a medical office setting or healthcare environment is highly desirable. This role is perfect for motivated professionals eager to utilize their coding expertise in a remote setting while contributing to the integrity of healthcare billing practices. We are committed to supporting your professional development through ongoing education on industry standards such as DRG classifications and ICD coding updates—empowering you to excel as a key player in our auditing team! Job Type: Temporary Pay: $21.00 - $23.00 per hour Expected hours: 28 per week Work Location: Remote Apply tot his job Apply tot his job Apply To this Job