Healthcare Auditor & Coding Consultant, Forensics and Compliance

At Stout were dedicated to exceeding expectations in all we do we call it Relentless Excellence . Both our client service and culture are second to none stemming from our firmwide embrace of our core values: Positive and Team-Oriented Accountable Committed Relationship-Focused Super-Responsive and being Great communicators. Sound like a place you can grow and succeed Read on to learn more about an exciting opportunity to join our team.

• Contribute to complex healthcare consulting engagements involving coding and billing audits disputes claims analysis investigations compliance reviews and litigation support.
• Deliver accurate defensible analyses across inpatient and outpatient facilities ambulatory surgery centers (ASCs) and professional fee services.
• Identify clinical documentation coding billing reimbursement contractual regulatory and fraud waste and abuse risks from provider and payor perspectives.
• Translate complex medical record claims reimbursement and contract information into practical recommendations that inform client decisions and regulatory or legal responses.

• Review medical records claims charge detail billing data reimbursement data policies and contracts for accuracy support and compliance.
• Audit ICD-10-CM ICD-10-PCS CPT HCPCS Level II modifiers units revenue codes and related coding requirements across facility and professional settings.
• Evaluate MS-DRG APR-DRG APC ASC and professional fee reimbursement methodologies including Medicare Medicaid commercial and payor-specific rules.
• Assess clinical documentation medical necessity level of care patient status utilization review coverage and clinical-to-code alignment.
• Analyze the end-to-end revenue cycle and claims lifecycle including charge capture coding billing claims submission and adjudication denials appeals recoupments collections and patient responsibility.
• Review health plan provider contracts reimbursement terms coverage policies claims processing practices and payment determinations.
• Plan and conduct risk-based audits investigations and forensic analyses; identify patterns outliers root causes and potential overpayments or underpayments.
• Develop clear reproducible workpapers calculations findings and recommendations that support defensible conclusions.
• Prepare reports and client-ready deliverables and support regulatory responses disputes expert reports depositions or testimony as needed.
• Collaborate with clients legal counsel clinicians coding and billing teams health plan personnel and engagement teams; provide technical guidance and support consistent audit practices.

• Bachelors degree in Health Information Management nursing healthcare administration business or a related field or an equivalent combination of education and experience.
• 5-10 years of progressively responsible experience in healthcare coding billing auditing reimbursement revenue cycle payment integrity or claims operations.
• Demonstrated hands-on experience with inpatient facility outpatient facility ASC and professional fee coding billing auditing and reimbursement.
• One or more active coding auditing billing or HIM credentials preferred such as CCS CIC CPC COC CPMA CHCA/CHCAF CPB RHIT RHIA or a comparable credential.
• Advanced knowledge of applicable coding guidelines reimbursement methodologies payor policies CMS requirements HIPAA the False Claims Act and healthcare compliance principles.
• Proven ability to analyze complex medical records and claims data manage audit work document methodology and communicate findings clearly in writing and verbally.
• An active RN license another clinical credential or substantial clinical experience is preferred.
• Prior experience as an HIM director or in comparable HIM coding clinical documentation revenue integrity or compliance leadership is preferred.
• Health plan contracting experience involving provider agreements and reimbursement terms is preferred.
• Health plan claims processing or adjudication experience including payment integrity coverage policy denials appeals or recoupments is preferred; litigation consulting or expert witness support experience is also valued.

• Integrate clinical coding operational contractual and payor perspectives to solve complex healthcare problems.
• Exercise sound judgment objectivity discretion and attention to detail while managing multiple priorities and deadlines.
• Communicate technical concepts clearly to clinical operational executive regulatory and legal audiences.
• Take ownership collaborate effectively mentor others and consistently deliver high-quality work.
• Demonstrate integrity and embody Stouts core values: Positive and Team-Oriented Accountable Committed Relationship-Focused Super-Responsive and Great Communicators while delivering Relentless Excellence.

Why Stout
At Stout we offer a comprehensive Total Rewards program with competitive compensation benefits and wellness options tailored to support employees at every stage of life.

We foster a culture of inclusion and respect embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.

We invest in professional growth through ongoing training mentorship employee resource groups and clear performance feedback ensuring our employees are supported in achieving their career goals.

Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.

Learn more about our benefits and commitment to your success.

specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.

Stout is an Equal Employment Opportunity.All qualified applicants will receive consideration for employment on the basis of valid job requirements qualifications and merit without regard to race color religion sex national origin disability age protected veteran status or any other characteristic protected by applicable local state or federal law.

Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience education level and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.

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