Senior Coding Auditor

AIM HealthCare Services, Inc. is a nationally recognized consulting firm, based in Nashville, Tennessee, that was established in 1995 and has grown from 2 employees to over 1800 in 2007. We provide consulting services to Insurance companies and Hospitals throughout the nation.

We are currently seeking an enthusiastic, success-driven professional to join our team as a Senior Coding Auditor. AIM is looking for experienced self-starters who are looking for an opportunity to grow with their company.

The Senior Coding Auditor will be using knowledge, experience, and client specific policy and procedures to develop queries that provide consistent revenue stream to company and client in collaboration with Specialty Audit Service Management. Queries will be driven by provider profiling, trending based on identification of provider coding and sequencing fallacies, in addition to the provider failing to follow client’s pre-determined policies and procedures.  Foster relationships with staff and company that lead to independent thinking of same.

Job Functions:
• Develop, implement, and maintain quality queries that identify coding opportunities and suspect reimbursement using knowledge of claims processing, client P&P, procedural coding, diagnosis coding, DRG, OPPS, and specific regulations.
• Ensure accuracy of proper code assignment, DRG and APC assignment utilizing coding guidelines and appropriate documentation in the medical record. 
• Ability to understand, analyze, and comply with payer regulations, the potential impact of the chargemaster on reimbursement, and coding principles.
• Provide subject matter expertise in all aspects of coding applications to staff, clients, and co-workers by keeping abreast of federal, state, and local changes in coding and reimbursement.
• Work in collaboration with management to identify value adds to clients that aid in contract negotiations, potential cost avoidance, containing costs, and minimizing provider abrasion.
• Apply experience in auditing of procedural and diagnosis coding for all specialties that lend to identified client savings.
• Apply experience in DRG validation to identify opportunities in coding changes that lend to client savings.
• Ability to be highly productive, multitask and work under aggressive deadlines while possessing effective analytical, oral and written communication skills
• Foster relationships and work in collaboration with internal and external customers.
• Utilize current experience and continue to develop knowledge that continually sets the stage for innovative strategies to place revenue in the client and company’s hands, consistently.

Education/Experience

• 5-10 years of progressive operations experience in healthcare claims processing.
• AHIMA certification required as a RHIA, RHIT, and/or CCS with consulting experience helpful.  CPC and Registered Nurse also a plus.
• Thorough understanding of hospital and physician claims coding, diagnosis coding, procedure coding, DRG validation, and understanding of how claims processing systems are used in claim adjudication, claims data records, system outputs, and their uses.
• Previous experience in coding assignment and auditing for all disciplines; inpatient, outpatient, ancillary, physician, surgery, general and interventional radiology, emergency, laboratory, and heart catheterization.
• Knowledge of current CMS guidelines, specific Medicare regulation, including but not limited to IPPS and OPPS.
• Familiarity with reimbursement methodologies, such as RBRVS, ASC groupers, NCQA, APC’s, Case rates, DRG, fee schedules, and AWP.
• Demonstrated ability to successfully communicate with people at all levels of the organization.
• Demonstrated analytical, organizational, verbal, and written communication skills.



In addition to competitive salary, we provide a full range of benefits including medical, dental, life, short and long term disability, vacation, personal days, and a matching 401k. AIM will reimburse expenses required for maintaining credentials. For immediate consideration apply online by using the following link: https://www.aimhealth.com/ats/JobDetails.aspx?id=2211 Applications & resumes without a specific salary requirement will not receive first consideration. No phone calls please.


Please visit our website for more information regarding AIM HealthCare Services at: www.aimhealth.com

AIM Healthcare Services, Inc. is an equal opportunity employer