About this role
This is a remote position.
Certified Medical Coder/Medical Record Audit Specialist - Behavioral Health
Location: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)
Job Summary:
We are seeking a Certified Medical Coder/Medical Record Audit Specialist with strong Behavioral Health coding experience to support a state Medicaid program engagement. This role focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issues, and preparing audit work-papers and reports in alignment with CMS, AHIMA, and Indiana Medicaid standards.
Key Responsibilities
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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.
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Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer.
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Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.
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Maintain detailed work-papers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
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Assist with audit responses and appeals as needed.
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Ensure all work aligns with state, federal, and national coding and reimbursement guidelines.
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Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates.
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Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
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Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.
Requirements
Required Qualifications:
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Active coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC).
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Minimum 2-3 years of hands-on medical coding, claims review, or audit experience
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Significant experience coding Behavioral Health, Mental Health, or Psychiatric encounters
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Hands-on proficiency with ICD-10-CM, CPT, and HCPCS coding systems
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Experience conducting medical record audits, claims reviews, or supporting appeals
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Comfortable completing a timed Excel proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the client prior to submission
Preferred Qualifications
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Familiarity with Indiana Medicaid (IHCP) policies and payer guidelines
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Knowledge of CMS regulations and AHIMA Standards of Ethical Coding
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Experience with Epic, Cerner, 3M Encoder, or similar EHR and encoder platforms
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Prior experience specifically supporting Medicaid audit or compliance functions.
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