Medical Record Audit Specialist

Certified Medical Coder/Medical Record Audit Specialist - Behavioral Health

Location:

Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)

Job Summary:

We are seeking a Certified Medical Coder/Medical Record Audit Specialist with strong Behavioral Health coding experience to support a state Medicaid program engagement. This role focuses on auditing medical records and claims documentation for coding accuracy and compliance, identifying billing and documentation issues, and preparing audit work-papers and reports in alignment with CMS, AHIMA, and Indiana Medicaid standards.

Key Responsibilities

• Review medical records and related documentation to assess coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
• Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer.
• Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues.
• Maintain detailed work-papers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
• Assist with audit responses and appeals as needed.
• Ensure all work aligns with state, federal, and national coding and reimbursement guidelines.
• Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates.
• Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.
• Requirements

Required Qualifications:

Active coding certification: CCS (AHIMA), CPC (AAPC), or CPMA (AAPC). Minimum 2-3 years of hands-on medical coding, claims review, or audit experience Significant experience coding Behavioral Health, Mental Health, or Psychiatric encounters Hands-on proficiency with ICD-10-CM, CPT, and HCPCS coding systems Experience conducting medical record audits, claims reviews, or supporting appeals Comfortable completing a timed Excel proficiency assessment (sorting, filtering, VLOOKUP, conditional formatting), required by the client prior to submission Preferred Qualifications Familiarity with Indiana Medicaid (IHCP) policies and payer guidelines Knowledge of CMS regulations and AHIMA Standards of Ethical Coding Experience with Epic, Cerner, 3M Encoder, or similar EHR and encoder platforms Prior experience specifically supporting Medicaid audit or compliance functions.