RADcube - A NLogix Company

Role Description We are seeking a detail-oriented Certified Medical Coder / Medical Record Audit Specialist to support coding accuracy, medical record review, and billing compliance activities for Indiana Medicaid programs. This role is responsible for: - Reviewing medical records and claims-related documentation for coding accuracy. - Identifying billing and compliance issues. - Preparing audit documentation and reports. - Supporting appeals activities. The ideal candidate brings strong coding knowledge, regulatory awareness, and analytical and writing skills. This is a remote position with occasional travel required within Indiana. Qualifications - Coding certification such as CCS, CPC, or CPMA required. - At least 1 year of medical coding, claims review, billing compliance, or related healthcare reimbursement experience. - Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred. - Candidate located in or near the Indianapolis area preferred. - Proficiency in Microsoft Excel, Word, and Outlook. - Strong analytical, critical thinking, problem-solving, and technical writing skills. - Ability to work independently and collaboratively in a fast-paced environment. - Experience working with healthcare providers strongly preferred. - Knowledge of healthcare claims data and fraud, waste, and abuse preferred. Requirements - Review medical records and related documentation to assess coding accuracy and compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations. - Conduct coding and documentation reviews independently and provide preliminary findings to the Lead Reviewer. - Identify potential coding discrepancies, documentation deficiencies, and billing compliance issues. - Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached. - Assist with audit responses and appeals as needed. - Ensure all work aligns with state, federal, and national coding and reimbursement guidelines. - Stay current on CPT, HCPCS, ICD-10-CM, and Medicaid coding guidelines, policies, and regulatory updates. - Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures. - Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines. Company Description

Role Description We are seeking a detail-oriented Healthcare Data Analyst / Algorithm Developer to support healthcare data analysis, coding logic development, and program integrity activities for medical coding, medical record review, and billing compliance functions. This role is responsible for: - Analyzing claims and encounter data. - Developing and refining data-driven algorithms and review logic. - Identifying coding and billing patterns. - Producing actionable insights to support clinical, operational, and financial decision-making. The ideal candidate brings strong SQL and data analysis skills, a solid understanding of healthcare reimbursement data, and working knowledge of CPT, HCPCS, and ICD-10 coding concepts. This individual will work closely with coding, clinical, and audit teams to: - Translate business rules and policy requirements into queries, logic models, audit targeting methodologies, dashboards, and analytic outputs. - Exhibit strong analytical thinking, attention to detail, and the ability to interpret healthcare data in support of audit readiness, payment integrity, and compliance monitoring. Qualifications - Bachelor’s degree in data analytics, health information management, informatics, public health, healthcare administration, statistics, computer science, or a related field preferred. - At least 2 years of experience in healthcare data analysis, claims analysis, payment integrity, program integrity, revenue cycle analytics, or related work preferred. - Strong experience with SQL required, including writing complex queries, joining large datasets, aggregating results, and validating outputs. - Working knowledge of medical coding concepts, including CPT, HCPCS, and ICD-10, strongly preferred. - Experience working with healthcare claims or encounter data required; Medicaid experience strongly preferred. - Familiarity with healthcare billing, reimbursement, documentation review, audit support, or compliance monitoring preferred. - Experience developing logic models, analytic rules, dashboards, or automated reporting solutions preferred. - Proficiency in Microsoft Excel required; experience with data visualization and reporting tools preferred. - Strong analytical, critical thinking, problem-solving, and organizational skills. - Ability to communicate technical findings clearly to non-technical audiences. - Strong attention to detail and ability to manage multiple datasets, priorities, and deadlines. - Ability to work independently and collaboratively in a fast-paced environment. Requirements - Ability to translate complex healthcare policy and coding requirements into clear analytic logic. - Strong understanding of claims structures, provider billing behavior, and reimbursement data relationships. - Experience identifying outliers, trend shifts, and risk indicators through targeted data analysis. - Ability to prepare concise, decision-ready summaries of findings for operational and leadership audiences. - Comfort working in an environment that combines data analytics, coding review, audit support, and compliance monitoring. - Experience supporting initiatives related to payment integrity, fraud waste and abuse detection, utilization review, or billing compliance is strongly preferred. Company Description

Role Description We are looking for a Senior Data Analyst with 10+ years of experience at the intersection of SQL, medical coding (CPT-4, ICD-10), and healthcare revenue cycle operations. This is a senior individual contributor role requiring deep technical expertise, strong domain knowledge, and a proven record of translating healthcare data into measurable financial and clinical impact. Key Responsibilities - Develop and maintain MySQL/MSSQL stored procedures, batch-scripted reporting systems, and data pipelines supporting revenue cycle operations ($3M+ annually). - Analyze healthcare claims data segmented by provider, service type, and time period to drive clinical and financial decisions. - Apply expert-level CPT-4, ICD-10, and HCPCS coding knowledge - including modifier usage, surgical coding, fee schedules, and carrier-specific rules. - Manage EDI transaction workflows: ANSI ASC X12N 837P, 835, 277CA, and 999 to maximize clean claim rates and reduce denials. - Consult with practice leadership on CPT utilization strategy, revenue projections, and coding compliance. - Support HIPAA-compliant data architecture and HL7 middleware integrations between practice management and billing systems. - Deliver executive-ready dashboards and parameterized reporting tools enabling timely leadership decisions. Qualifications - 10+ years in Data Analysis within healthcare or medical billing environments. - Expert-level SQL - MySQL/MSSQL stored procedures, database design, performance tuning, and automation. - 10+ years of hands-on CPT-4 and ICD-10 coding - procedure/surgical coding, modifiers, and insurance carrier rules. - EDI experience: ANSI ASC X12N 837P, 835, 277CA, 999 transaction sets. - HIPAA compliance knowledge applied to data handling and system architecture. - Demonstrated revenue impact through data-driven solutions ($1M+ preferred). - Bachelor’s degree in computer science, Mathematics, Business, or equivalent experience. Requirements - HL7 middleware integration experience for patient data exchange and lab requisition workflows. - AWS cloud experience: instance deployment, VPC/firewall configuration, encrypted data transfers. - Multi-client medical practice management or revenue cycle consulting background.