Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations

Impact You’ll Make

This section outlines the key outcomes and contributions expected from the role. It highlights how your work will shape engagements, support clients, and drive value across Stout’s Healthcare Consulting practice.

• Contribute to complex healthcare consulting engagements involving coding audits, disputes, claims analysis, and investigations.
• Deliver high-quality, accurate coding analysis that informs client decisions, regulatory responses, and litigation support.
• Identify risks related to billing, coding, and reimbursement, including potential fraud, waste, and abuse.
• Support the development of defensible findings and recommendations through detailed documentation and analysis.
• Enhance Stout’s reputation for excellence by applying deep expertise in inpatient coding, reimbursement systems, and compliance.

This section outlines the core responsibilities and day-to-day duties of the role. These tasks are designed to help you achieve desired outcomes while supporting team and organizational goals.

• Perform detailed reviews of inpatient medical records to assess accuracy of ICD-10-CM/PCS coding and alignment with clinical documentation.
• Analyze coding, billing, and reimbursement practices across engagements involving audits, disputes, and investigations.
• Support forensic analyses to identify compliance risks, inefficiencies, and reimbursement discrepancies.
• Assist in audits, regulatory reviews, and litigation support by gathering evidence, analyzing issues, and contributing to reporting.
• Evaluate DRG/APR-DRG/APC assignments and reimbursement implications based on clinical documentation.
• Collaborate with internal teams, clients, and legal counsel to support engagement objectives.
• Prepare clear, well-structured reports, analyses, and client-ready deliverables summarizing findings and recommendations.
• Monitor coding trends, denials, billing edits, and regulatory updates to inform analyses and engagement insights.
• Contribute to internal knowledge sharing and continuous improvement within the Healthcare Consulting practice.

This section details the skills, qualifications, and experience needed to excel in the role.

• Bachelor’s degree in Health Information Management or related field (or equivalent experience).
• Minimum of five (5) years of recent acute-care inpatient facility coding experience.
• Strong experience with DRG and PCS coding, including auditing; denials experience preferred.
• Active coding credential required (CCS, CIC, RHIT, or RHIA).
• Knowledge of MS-DRG, APR-DRG, APC methodologies and reimbursement frameworks.
• Experience reviewing clinical documentation for accuracy, compliance, and reimbursement optimization.
• Familiarity with healthcare regulatory frameworks (e.g., CMS, HIPAA, False Claims Act).
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with data visualization tools is a plus.
• Strong analytical, problem-solving, and written/verbal communication skills.

This section highlights the competencies and behaviors that will set you up for success in this role and align with Stout’s culture.

• Analytical and Detail-Oriented:
  Ability to interpret complex clinical and coding data and draw well-supported conclusions.
• Collaborative and Client-Focused:
  Works effectively with cross-functional teams and builds strong client relationships.
• Accountable and Proactive:
  Takes ownership of work, manages priorities, and delivers high-quality results on time.
• Adaptable and Curious:
  Thrives in a fast-paced consulting environment and continuously learns new regulations and methodologies.
• Quality and Integrity Driven:
  Demonstrates commitment to ethical coding practices and compliance standards.
• Aligned with Stout Values:
  Embodies Relentless Excellence®…