Medical Coding Auditor / Coding Validation Reviewer

United StatesRemoteFull-timemid

OtherAuditor

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Quick Summary

Overview

This position is listed on behalf of a partner company, who manages all applications and next steps.

Technical Tools

OtherAuditor

This fully remote role supports Veterans Affairs medical centers across Georgia, Alabama, and South Carolina.
You will conduct independent coding audits covering inpatient, outpatient, and professional fee services across multiple specialties.
The position plays a critical role in validating coding accuracy, compliance, documentation, and financial impact.
You will analyze sampled medical records, identify and substantiate coding errors, and produce clear audit findings.
Beyond auditing, you will help strengthen coding practices through targeted education and train-the-trainer sessions.
The role combines technical coding expertise, analytical judgment, report writing, and stakeholder communication.
The initial engagement is 12 months, with the potential for four additional 12-month option periods.

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

~2 min read

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.