Healthcare Auditor & Coding Consultant, Forensics and Compliance

At Stout, we're 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 over payments or underpayments.
• Develop clear, reproducible work papers, 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.

• Bachelor's 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…