Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).


Start Over with Job Search
Returning Applicant?  Login Now

Medical Coding Auditor II - Outpatient
Job Code:2023-53-R-002
Location:United States - Remote
Status:Regular Full Time
Pay Range:26.00-32.00
As a member of our medical audit team, the Outpatient Medical Coding Auditor (Focus Facility Surgical Procedures) will have an opportunity to make a direct contribution to the company’s bottom line in our rapidly growing healthcare business. You will leverage your coding knowledge, and medical claims experience to identify client records with billing coding issues as well as investigative and auditing opportunities.
You will help identify and refine new issues for Performant to present to our clients for audit strategy, proof of concept development, and assist in developing training material or assist in training for new issues. You must possess a unique blend of medical coding experience, business aptitude and understanding of payables/receivables, commitment to excellence, critical eye for quality and accuracy, team spirit and the self-drive to meet and exceed productivity goals. 

You must enjoy spending time solving puzzles, researching, and giving attention to detail. Your depth in knowledge of medical billing standards and systems, and adaptability applying those skills will allow you to have an immediate impact to the team. Candidates who will thrive in this collaborative environment enjoy variety in their work and are willing to learn new systems and client requirements, anytime and anywhere. 

If you are ready to use your strengths in medical coding, keen eye for identifying issues, and passion for excellence in a new way, this is the job for you!  Performant Financial Corporation is a provider of technology workflow management solutions for various government, healthcare and financial services markets. We focus on audit and recovery services through our proprietary technology platform, combined with robust data analytics and experience gathered through decades of proven processes. 

Our base technology, workflow management processes and data management are flexible and extensible, as proven by our ability to service complex and competitive markets.  Performant is committed to:
•Accurate auditing of payment streams
•Efficient recovery of past due receivables
•Intelligent management of financial assets
We provide services in highly regulated arenas in the public and private sector and we are committed to work in compliance with the laws and regulations that govern the industries we serve.

What you will do:
•Objectively and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity and quality expectations.
•Conduct review of flagged claims and Fraud Waster & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. 
•Timely review and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding. 
•Appropriately refer reviews for clinical validation,  and communicate with and provide guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements. 
•Enter and update all contract and/or review findings a supporting documentation into the audit processing system.
•Write logic/parameters for system edits to detect incorrect coding over payments, aberrant and abusive coding patterns.
•Proof of concept development and data analysis of reports for potential edit development.
•Monitor CMS and major payer coding and reimbursement policies.
•Assist in identifying new issues/investigative strategies for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation.
•Maintain a current knowledge of all Medicare and Commercial regulations, policies and procedures, as well as requirements defined in assigned client(s) Statement(s) of Work (SOW).
•Maintain certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certification(s), as well as HIPPA and other compliance training provided by Performant and client(s).
•Develop and maintain professional working relationships within the department and cross-functionally.
•Notify management of:
* all correspondence indicating displeasure with the Remittance Advice (RA), in the over payment identification, or in the recovery methods utilized,
* legal action, or 
* government intervention
•Assist in developing material for training and facilitate or assist in audit training sessions.
•Assist in educating Performant team members on coding, policies, regulations, appeal strategies, etc. as needed.
•Attend conference calls and meetings as requested.
•Demonstrate Performant’s company core values as a member of the team in performing one’s role:
 *People – respect for others, diversity and professionalism in communications and conduct
 *Innovation – adaptability, and flexibility in applying skills in our dynamic business environment. Creativity and open minded in solving issues in our teams, in development and delivery of our products, and for our clients.
 *Excellence – commitment to compliance, quality and achievement of business goals and results for our clients and for our business.
•Perform miscellaneous duties as assigned required to meet business needs in a highly professional manner.

*Note - All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Required Skills and Knowledge:

•Possess knowledge of CMS rules and regulations
•Proficient in the use of MCS 1500/UB 04 forms
•Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10, MS-DRG coding
•Working knowledge of encoder
•Proven ability to review, analyze, and research coding issues
•Reimbursement policy and/or claims software analyst experience
•Familiarity with interpreting electronic medical records (EHR)
•Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing
•Courteous, professional, and respectful attitude
•Adaptability of skills to handle any non-standard situations that may arise or apply skills in new ways as may be required to meet business needs
•Ability to multi-task effectively and work independently in a remote setting 
(*Must have acceptable home internet connection and meet requirements of Performant Teleworking Policies for remote work eligibility) 
•Attention to detail
•Excellent written and verbal communication skills
•Typing skills, comfortable navigating and using desktop technology, as well as working knowledge of MS Office applications (Outlook, Word, Excel).
Additional Requirements:

•Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.

•Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

Physical Requirements:

**NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff may be notified and required to work from a Performant office location on an ad-hoc or periodic basis.

Basic office equipment required to perform remote work is provided by the company.
•Job is performed in a standard busy office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse.
•Reads and comprehends information in electronic (computer) or paper form (written/printed). 
•Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
•Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
•Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
•Occasionally lift/carry/push/pull up to 10lbs.
Education and Experience:

• Active Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P required.

• 3+ years of direct experience in coding/auditing outpatient services, and medical chart review for all provider/claim types for outpatient facility.

• Coding for emergency care, observation and same day surgery highly desired. 

• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.

• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.


Other Requirements:

Performant is a Government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and clearances (as applicable).
•Must submit to and pass pre-hire background check, as well as additional checks throughout employment.
•Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
•Must submit to and pass drug screen pre-employment (and throughout employment).
•Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.

Applicants must have reliable, secure, high speed Internet access at their home office location.
Employment VISA Sponsorship is not available for this position

Job Profile is subject to change at any time.

Performant Financial Corporation is an Equal Opportunity Employer. 
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.