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:
As a Certified Professional Coder with HMA, you will have the opportunity to further advance in your career as an integral part of our payment integrity efforts for our self-insured clients. We are looking for an experienced, consultative CPC who will enjoy capturing disallowances due to policies and guidelines and optimizing the processes and efforts of our Coding Policy Review program.
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.

Knowledge, Experience, and Key Attributes needed for Success:

• Current Certified Professional Coder certificate required
• 3-5 years of health plan experience
• 3+ years of medical code auditing experience
• 3+ years with Microsoft Office applications (Outlook and Word) and Adobe required
• Experience in the application of common coding and billing standards including the American Medical Association CPT (Current Procedural Terminology), the Centers for Medicare and Medicaid Services National Correct Coding Initiative, Optum Coding resource manuals, the UB04 Billing Manual coding guidelines, and the National Uniform Billing Committee
• Strong problem-solving and critical thinking skills
• Strong client-facing verbal and written communication skills
• Motivated self-starter with the ability to work independently
• Enjoys the pace and rhythm of a deadline-oriented environment requiring strong prioritization skills

Compensation The base salary range for this position in the greater Seattle area is $29/hr - $32/hr for a level I and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

How we Support your Work, Life, and Wellness Goals
At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
HMA requires a background screen prior to employment.
Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer.
For more information about HMA, visit www.accesshma.com .