Medical Coding Auditor / Coding Validation Reviewer
Accountabilities Conduct independent external audits of coded medical records, covering inpatient facility/DRG, outpatient facility, inpatient professional services, surgery, urgent care, clinic visits, and ambulatory surgery.
Review up to the first 25 diagnoses and 25 procedures on each applicable record for both facility and professional services.
Help develop statistically valid audit samples targeting a 95% confidence level and a minimum of 10% of applicable records, as well as supporting data-collection tools.
Review facility-specific HIMS policies and coding procedures before beginning each audit.
Identify and classify coding, diagnosis, modifier, documentation, and compliance errors, supporting findings with appropriate coding references.
Prepare facility-level audit reports addressing coding accuracy, financial impact, significant findings, and areas requiring attention, while contributing to broader network-level reporting.
Present draft findings to HIMS leadership, Contracting Officer’s Representatives, and facility leaders within required timelines and deliver final reports within 15 business days.
Develop facility-specific education plans based on audit findings and conduct train-the-trainer sessions of at least two hours using real-world charts.
Provide education to coding professionals, managers, and physicians and facilitate exit conferences with Health Information Management leadership.
Maintain accurate audit documentation and communicate findings clearly to both technical coding audiences and non-coding stakeholders.
Requirements
Hold an active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.
Have at least 3 years of coding experience , including experience consulting on medical record reviews for large tertiary-care hospitals and outpatient organizations covering diverse specialties and primary care.
Have at least 3 years of education and training experience , such as educating coders, providers, or clinical staff.
Demonstrate expert knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI edits .
Have completed an accredited coding, Health Information Management, or Health Information Technician program.
Provide two current client references able to speak to previous audit work, along with proof of active credentials and a current resume as required for the contract proposal.
Be a U.S. citizen and able to successfully complete a federal background investigation, including NACI and fingerprinting.
An additional auditing credential such as CDIP, CPMA, or CIC is preferred.
Prior experience auditing for the VA or another federal healthcare system is highly desirable.
Demonstrate strong report-writing, presentation, communication, analytical, and teaching skills, including the ability to explain complex findings in plain language.
Complete required annual VA Privacy and Information Security Awareness and HIPAA training, including TMS 10176 and 10203.
Be able to travel to VA facilities when authorized by the government; approved travel is reimbursed according to applicable federal travel regulations.
Benefits
$25.00–$30.00 per hour .
100% remote position available to candidates in the United States.
Initial 12-month term , with four potential additional 12-month option periods.
Opportunity to support VA medical centers across Georgia, Alabama, and South Carolina .
Work focused on improving coding accuracy, compliance, education, and healthcare data quality for veteran-serving facilities.
Approved business travel reimbursed in accordance with federal travel regulations.
Mission-driven environment supporting federal healthcare operations.
Opportunity to apply advanced coding, auditing, education, and healthcare data expertise across a large-scale program.
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