Medical Coding Auditor I

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Medical Claims Coding Auditor and Itemized Bill Reviewer plays a critical role in ensuring the accuracy, compliance, and cost-effectiveness of medical claims. This position is responsible for auditing medical records and itemized bills to validate coding accuracy, identify billing discrepancies, and support cost containment strategies. The ideal candidate has a strong background in medical coding, billing practices, and regulatory compliance, with a keen eye for detail and a commitment to integrity. What YOU will do: Claims Auditing & Review Conduct detailed audits of medical claims and itemized bills to ensure accuracy and compliance with coding standards (ICD-10, CPT, HCPCS). Identify and document billing errors, upcoding, unbundling, and other discrepancies. Review high-dollar claims and complex cases for potential overcharges or inappropriate billing. Coding Validation Validate diagnosis and procedure codes against medical documentation. Ensure coding aligns with payer policies, CMS guidelines, and industry best practices. Cost Containment & Recovery Support cost containment initiatives by identifying opportunities for claim reductions or denials. Assist in the development of audit strategies to target high-risk claims. Compliance & Quality Assurance Stay current with changes in coding regulations, payer guidelines, and healthcare laws. Participate in internal quality assurance programs to ensure audit consistency and accuracy. Provide feedback and training to internal teams on coding and billing best practices.