Audit Defense Auditor & Coder

CareCloud; New Jersey; On-site; USD 75,000 - 110,000; Full time

Job summary

Empower Healthcare and Compliance Partners, a subsidiary of CareCloud, seeks an experienced Audit Defense Auditor/Coder in New Jersey to lead regulatory audits for coding teams and ensure compliance with CMS and payer guidelines. The role requires strong clinical documentation knowledge and coding expertise.

You will mentor audit teams, prepare final reports, and assist with appeals of regulatory determinations, collaborating with Compliance and Legal to improve provider documentation and coding

Qualifications

• Background dealing with payor audits, legal defenses, appeals/denials.
• Proficiency in Medical Coding and strong knowledge of Medical Terminology.
• Experience with Coding Standards and familiarity with Health Information Management principles.
• CPC certification or equivalent credentials.
• Bachelor’s degree in a related field or relevant work experience is preferred.

Responsibilities

• Lead regulatory audits for coding teams.
• Ensure completion of projects to meet regulatory / departmental deadlines.
• Provide business and/or subject matter expertise for regulatory audits.
• Communicate and collaborate with management to assemble, and mentor, audit coding team(s) to ensure deliverables are met or exceeded.
• Ensure audit compliance with CMS Coding Guidelines and Payer Coding Guidelines.
• Review and analyze weekly reports to ensure appropriate quality review performance and results.
• Prepare final audit reports per exact specifications for Audit Defense or Client Audit.
• Assist Legal with Appeals of Regulatory Audit final determinations. Interface with Compliance and Legal regarding Appeals of Regulatory Audit final determinations.
• Conduct data analyses from medical record reviews to identify opportunities to improve provider documentation and coding.
• Interface with client revenue programs for provider education teams to identify educational opportunities for targeted providers. Identify and collaborate in developing process improvement initiatives.
• Participate in all Regulatory Audit training, monitor publications from regulatory agencies, to make updates to current processes ensure audit coding compliance.
• Other duties as assigned or requested.

Skills

Regulatory audits

Medical coding

CMS guidelines

Payer audits

Analytical skills

Communication

Education

Associate degree in healthcare

Job description

Empower Healthcare and Compliance Partners, a subsidiary of CareCloud, seeks an experienced Audit Defense Auditor/Coder in New Jersey to lead regulatory audits for coding teams and ensure compliance with CMS and payer guidelines. The role requires strong clinical documentation knowledge and coding expertise.

You will mentor audit teams, prepare final reports, and assist with appeals of regulatory determinations, collaborating with Compliance and Legal to improve provider documentation and coding