Lead Coding Auditor, Itemized Bill Review and Appeals

Gainwell Technologies

. Perform itemized bill review, chart review, and coding validation .

Posted 9/15/2026full-timeRemote • Texas • United StatesSenior💰 $78,000 - $88,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical record auditing, coding validation, and appeals processes, with a strong focus on maintaining compliance with coding guidelines and achieving productivity standards. Proficient in utilizing proprietary auditing systems and effectively communicating case findings and rationales.

Highest-signal resume keywords

CPC CertificationICD-10-CM CodingInpatient Hospital Bill AuditingExcellent Written CommunicationMicrosoft Excel Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Coding ValidationMedical Record AuditingICD-10-PCS CodingCPT Coding MethodologyHospital Billing KnowledgeCharge Master ReviewAppeals Process KnowledgeCase File PreparationQuality Standards AchievementMulti-tasking in Fast-paced Environment

Soft Skills

Excellent Oral CommunicationMentoring and TrainingFeedback and Education

Tools & Technologies

Proprietary Auditing SystemsMicrosoft TeamsZoomMicrosoft WordMicrosoft PowerPointInternet Browsers

Certifications & Qualifications

CPCCOCCCSRHIARHIT

Industry Keywords

UB-04Itemized BillsRevenue CodesHCPCS CodesAppeals and Hearings Process

About the role

Key responsibilities & impact

Perform itemized bill review, chart review, and coding validation
Verify billed services and procedures were performed, covered, ordered, documented, and reimbursed according to policies and provider contracts
Evaluate coding, charging, and reimbursement for inpatient hospital and outpatient facility services
Use proprietary auditing systems to document audit findings and rationale
Review appeals and redeterminations using approved clinical and coding guidelines
Analyze appeal documentation and document appeal determinations
Prepare case files and case summaries for hearings
Participate in virtual and on-site hearings
Achieve productivity and quality standards
Cross-train to review multiple claim types
Assist management with training, monitoring, mentoring, feedback, and education for new Coding Auditors
Maintain current coding guideline knowledge and complete required CEUs
Attend training and scheduled meetings

Requirements

What you’ll need

At least one active professional credential through AHIMA or AAPC: CPC, COC, CCS, RHIA, or RHIT; required and maintained as a condition of employment
3+ years of experience in inpatient hospital bill auditing and outpatient facility coding with charge master review; strongly preferred
Working knowledge of the appeals and hearings process
Excellent written communication skills, including ability to write clear, concise, accurate, and fact-based rationales
Excellent oral communication skills for presenting case summaries and decisions
Ability to multi-task in a fast-paced production environment
Proficiency in medical record auditing and ICD-10-CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology
Strong knowledge of hospital billing/charging, including UB-04s, itemized bills, revenue codes, CPT/HCPCS codes, and ICD-10 diagnosis and procedure codes
Proficiency with Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, Microsoft Teams, Zoom, and similar virtual meeting tools

Benefits

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Benefits effective on Day 1
Clear career growth path
Training and leadership development opportunities
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Up to 25% travel for on-site hearing testimony