Medical Coder - Audit Specialist

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.

Requirements - 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.

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.