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…