Washington State L&I Medical Coding Compliance Auditor, Medical Program Specialist 1 in United States


Position is open until filled - Apply today!

Take your medical coding training and auditing experience to the next level with the Department of Labor & Industries. Join a professional team with a high work ethic dedicated to the review, analysis and monitoring of health services billed to the Department of Labor and Industries.

We are currently seeking a Medical Coding Compliance Auditor to perform complex medical coding audits. This position utilizes advanced medical coding knowledge to analyze patient medical records to ensure that a provider's services are billed in compliance with applicable laws, rules, policies and procedural coding guidelines.

Some of what you will do

  • Review medical records, interpret and apply L&I; payment policies, rules, laws and procedural coding guidelines (CPT®, HCPCs, local codes) in order to determine whether a provider's services were documented and billed appropriately.
  • Communicate analytical findings and directives to healthcare providers through the issuance of audit reports and legal orders.
  • Lead post audit discussions and negotiations with providers and/or attorneys to achieve resolution.
  • Draft settlement agreements.
  • Work with the state's Attorney General's office in preparation of court hearings and provide testimony at court hearings related to audit findings.
  • Perform quality assurance reviews of audits performed by other team members.
  • Provide consultative services to department staff and medical provider's regarding laws, rules and payment policies which affect payment to healthcare providers.

Who should apply - What we are looking for Written and oral communication skills are a critical function of this position. As an applicant, you must be able to demonstrate your expert level writing ability. Successful applicants must be able to work independently in addition to being a strong team player. The ability to communicate and receive constructive feedback from your team members is essential.

Preferred Education and Experience Bachelor's degree with a major study in public or business administration, nursing, health care administration or closely allied field; and three years of experience in medical coding/auditing;


Associates degree with a major study in public or business administration, nursing, health care administration or closely allied filed and certification or accreditation as a medical coding specialist (i.e. CCS, CPC, CPMA, CHCA); and two years of experience in medical coding/auditing.

(Medical coding/auditing experience we seek includes the review/analysis of medical documentation, the interpretation and application of healthcare policies, rules and laws, and the application of various healthcare coding structures including both CPT® and HCPCS Level II.)

The successful candidate will be required to obtain the Certified Professional Coder (CPC®) certification from the AAPC within 2 years from date of hire and maintain certification by obtaining ongoing CEUs (currently 36 CEUs every 2 years).

Experienced healthcare medical coder/auditor with the demonstrated ability to:

  • Objectively review medical documentation for appropriate procedural coding.
  • Understand and apply various healthcare coding structures (including both CPT® and HCPCS Level II).
  • Understand general medical terminology.
  • Interpret and apply laws, rules and policies related to the payment of healthcare services.
  • Apply critical thinking and analytical skills.
  • Effectively and professionally communicate complex information in both oral and written format in a way that is understandable to the audience.
  • Build rapport and partner with others.
  • Independently analyze and weigh the risks verses benefits in decisions and recommendations related to provider billing and bill audit issues.
  • Apply organization and time management skills with minimal supervision.
  • Manage multiple projects and assignments at one time.
  • Apply negotiation and conflict resolution skills.
  • Maintain confidentiality in the performance of this role.
  • Effectively use various computer applications (including: internet, Microsoft Word and Excel) to conduct research, create reports and detailed spreadsheets.

Note: please include a letter of interest/cover letter detailing your knowledge and experience related to this career opportunity. Supplemental Information

This job announcement may be used to fill multiple vacancies. Application review starts immediately and the hiring authority reserves the right to offer the job at any time. It's to your advantage to apply quickly.

Employees driving on state business must have a valid driver's license. Employees driving a privately owned vehicle on state business must have liability insurance on the privately owned vehicle.

Prior to any new hire into L&I;, a background check, including criminal record history, will be conducted.

To apply, follow the "Apply" link above

Jobs advertised as Open Continuous will be closed without notice. Apply quickly!

We're looking for evidence that you have what we're looking for. Your application materials will be used for deciding who'll be selected for interview.

For more information about the Department of Labor & Industries visit: http://www.lni.wa.gov/


Contact us at: Jobs@Lni.wa.gov

Persons with a disability, who need assistance in the application process, or those needing this announcement in an alternative format, may call (360) 902-5700. Applicants that are deaf or hard of hearing may call through the Washington Relay Service at 7-1-1.

The State of Washington is an Equal Opportunity Employer

Job Type: Full Time - Permanent

Job Number: 2016-02833

Department: Dept. of Labor & Industries

Agency: State of Washington

Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504.

Website: http://www.careers.wa.gov

Salary: $4,005.00 - $5,253.00 Monthly

Location: Thurston County – Tumwater, WA