Medical Coder Audit Specialist
Briljent · Remote
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.