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Medical Coding Auditor / Coding Validation Reviewer
Aptive Resources. Run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coding audits, compliance, and training within healthcare settings, with a strong focus on accuracy in coding practices and effective communication of findings. Proficient in developing data collection tools and conducting educational sessions for coding staff and management.
Highest-signal resume keywords
Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H CredentialICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI Edits Expertise3+ Years of Experience in Coding and AuditingStrong Report Writing and Presentation SkillsExperience in Training and Education
ATS Keywords
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Hard Skills
Coding AuditsData Collection Tool DevelopmentDiagnosis and Procedure ReviewStatistical SamplingCoding Error ClassificationAudit Report WritingTraining Plan CreationHealth Information Management Policies ReviewCompliance AuditingFederal Background Investigation Compliance
Soft Skills
Effective CommunicationLeadership in Training SessionsCollaboration with Healthcare LeadersAttention to DetailProblem-Solving
Certifications & Qualifications
Active RHIAActive RHITActive CCSActive CCS-PActive CPCActive CPC-HCDIP (Preferred)CPMA (Preferred)CIC (Preferred)
Industry Keywords
Veterans AffairsHealthcare ComplianceInpatient and Outpatient CodingTertiary Care HospitalsHealth Information ManagementHIPAA TrainingFederal Health System AuditingClient ReferencesPrivacy and Information Security AwarenessCoding Subspecialties
About the role
Key responsibilities & impact- Run external coding audits for Veterans Affairs medical centers in Georgia, Alabama, and South Carolina
- Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance
- Review up to the first 25 diagnoses and first 25 procedures on each record for facility and professional services
- Help build statistically valid samples using a 95% confidence level and at least 10% of records
- Develop data collection tools for each audit
- Review each facility's HIMS policies and coding procedures before audits
- Classify coding, diagnosis, modifier, documentation, and compliance errors, supporting each with coding references
- Write facility audit reports covering accuracy, financial impact, and areas of concern
- Contribute to a network-wide report
- Review draft findings with the HIMS Chief, COR, and facility leaders within 7 business days of the audit
- Deliver final reports within 15 business days
- Create facility-specific training plans
- Lead at least 2-hour train-the-trainer education sessions using real charts for coding staff, managers, and physicians
- Conduct exit conferences with Health Information Management leadership
- Travel to VA facilities only when authorized by the government
Requirements
What you’ll need- Active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential
- At least 3 years of experience as a consultant reviewing records for large tertiary care hospitals and outpatient organizations covering all subspecialties and primary care
- At least 3 years of education and training experience, such as teaching coders or providers
- At least 3 years of coding experience
- Two current client references who can speak to audit work
- Proof of active credentials and a current resume for the contract proposal
- Completion of an accredited coding, HIM, or health information technician program
- Expertise in ICD-10-CM/PCS, CPT, HCPCS, DRG/MS-DRG, APC, E/M, and NCCI edits
- US citizenship
- Ability to pass a federal background investigation (NACI) and fingerprinting
- Completion of the VA's annual Privacy and Information Security Awareness and HIPAA training (TMS 10176 and 10203)
- Preferred: auditing credential such as CDIP, CPMA, or CIC
- Preferred: experience auditing for the VA or another federal health system
- Preferred: strong report writing and presentation skills, including explaining findings in plain language for non-coders
Benefits
Comp & perks- 100% remote work within the US
- Approved travel reimbursed under federal travel regulations
- Annual Privacy and Information Security Awareness and HIPAA training
- Equal opportunity employment
- Veterans, Reserve and National Guard members, and transitioning active-duty service members are highly encouraged to apply