Healthcare Fraud Shield

Detects fraud, waste, abuse in healthcare

Coding Auditor

Clinical Support & Patient AdministrationUpdated on Nov 13

Full-timeChesterfield, MO, USANo salary listedRemote

About the Job

Requirements

Minimum of one year of investigative experience is required.
Must hold one of the following certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA).
Knowledge of medical terminology.
Knowledge of coding, including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes, Diagnosis-Related Group (DRG) Codes, and International Classification of Diseases, Tenth Revision (ICD-10).
Knowledge of specialty medical practices.
Ability to communicate effectively verbally and in writing.
Strong listening skills.
Ability to work independently, responsibly, and with self-discipline.
Ability to meet defined performance and production goals.
Strong computer skills.
Must exercise ongoing discretion and securely manage confidential and sensitive information.

Responsibilities

Compare procedures and codes billed on a claim with the medical record.
Compare information submitted on claims to determine the amount and nature of billable services as needed.
Determine the appropriateness of billing and reimbursement as needed.
Document findings for each claim line in a spreadsheet as needed.
Summarize findings in a written report as needed.
Abstract CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 information from medical records as needed.
Maintain current knowledge of coding guidelines and relevant federal and state regulations.
Comply with company privacy and security standards.
Do not use or disclose protected health information except as permitted or required by law.
Complete an average minimum of 5–10 claim-line reviews per hour.

The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation.

Compare the procedures and codes billed on a claim to a medical record.
Compare information submitted on the claims in order to determine amount and nature of billable services as needed.
Determines appropriateness of billing and reimbursement as needed.
Documents findings for each claim line in a spreadsheet as needed.
Summarize findings in a written report as needed.
Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed.
Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
Understands and complies with all company Privacy and Security standards.
Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
On average, there are a minimum of 5-10 claim line reviews per hour.
Other duties as needed.

Knowledge of medical terminology.
Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
Knowledge of specialty medical practices.
Must be detail oriented.
Ability to communicate effectively both verbally and in writing.
Strong listening skills.
Independent.
Responsible.
Self-disciplined.
Ability to meet defined performance and production goals.
Strong computer skills.
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Certificate/License:

Minimum of one year of investigative experience is required.
Required to have one of the following: CPC, CCS, CCA

About the Company

Healthcare Fraud Shield

Detects fraud, waste, abuse in healthcare

Healthcare Fraud Shield provides fraud, waste, and abuse detection solutions for the healthcare industry through the FWAShield suite. The products include pre-payment and post-payment analysis that flag ineligible claims by linking proprietary data sources with analytics, plus features like real-time queries, complex reports, and automated case management. It differentiates itself by adapting quickly to client needs and offering scalable, data-driven tools combined with customization and expert claims analysis. Its goal is to reduce financial losses from improper payments and maximize ROI for healthcare providers, insurers, and other stakeholders.

Company size: 51-200
Company stage: Late Stage VC
Total funding: $50M
Headquarters: Chesterfield, MO
Founded: 2011

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