Audit Defense Auditor-Empower

CareCloud

Franklin Township (NJ)

Hybrid

USD 90,000 - 130,000

Full time

11 hours ago

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Benefits offered by this job

Healthcare plans

401(k) with company match

Flexible spending accounts

Company-paid life insurance

Company-paid short and long-term/dis

Job summary

CareCloud is seeking an Audit Defense Auditor/Coder to lead detailed medical record reviews and coding audits, interfacing with clients and staff. The role emphasizes regulatory compliance, chart reviews, ICD-10/CPT coding, and producing precise findings for clients.

The ideal candidate has extensive experience in clinical documentation auditing, payer audits, and CMS guideline application, with strong communication and collaboration skills for cross-functional teams.

Qualifications

5+ years’ experience with clinical documentation auditing.
Minimum 1 year in audit defense or
3+ years of payer-side audit experience including medical record review, coding validation, CMS guideline application.

Responsibilities

Lead regulatory audits for coding teams.
Ensure completion of projects to meet regulatory deadlines.
Provide SME for regulatory audits and guidance to audit teams.
Mentor audit coding teams to ensure deliverables meet standards.
Ensure audit compliance with CMS Coding Guidelines and payer guidelines.
Prepare final audit reports per specifications for Audit Defense or client audits.

Skills

Analytical skills

Communication skills

Medical terminology

Regulatory compliance

Education

Associate’s degree in healthcare, clinical or business related

Bachelor’s degree preferred

Job description

Company Overview:

CareCloud is a leading provider of technology-enabled services and solutions that redefine the healthcare revenue cycle. We provide technology-enabled revenue cycle management and a full suite of proprietary cloud-based solutions to healthcare providers, from small practices to enterprise medical groups, hospitals, and health systems, throughout the United States. Healthcare organizations today operate in highly complex and regulated environments. Our suite of technology-enabled solutions helps our clients increase financial and operational performance, streamline clinical workflows, and improve the patient experience.

Empower Healthcare and Compliance Partners (Empower HCP) (subsidiary of CareCloud) is a leading healthcare compliance and networking firm dedicated to equipping providers and systems with the necessary tools, resources, and expertise to navigate the ever-changing regulatory landscape. We understand that compliance is the foundation of providing safe, ethical, and high-quality care to patients. Our mission is to empower healthcare organizations to meet compliance standards effectively, fostering better outcomes and trustworthy services in the healthcare industry.

Audit Defense Auditor/Coder

This job is responsible for the successful delivery of detailed and complex medical record reviews for Audit Defense and Regulatory Audits. The incumbent is responsible for interface with clients and staff. The incumbent is responsible for completion of coding audits review of medical records and coding for appropriate interpretation and designations including chart documentation review, ICD10 and CPT coding audit, and creating detail oriented, appropriate findings report for the client. Ensure compliance with required Regulatory Audit guidelines are being met with regards to coding and documentation.

ESSENTIAL RESPONSIBILITIES

Background dealing with payor audits, legal defenses, appeals/denials
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.

EDUCATION

Associate’s degree in healthcare, Clinical or Business Related

EXPERIENCE

5 years’ experience with clinical documentation auditing and a minimum of 1 year in audit defense or
(3 ) years of experience providing defensive support for CMS and payer audits through comprehensive chart reviews, coding validation, findings report preparation, and appeal support in accordance with regulatory guidelines or
(3 ) years of experience of payer‑side audit experience including medical record review, coding validation, and CMS guideline application.

Preferred

5 years of Coding Project Management

To Include:

3 years of monitoring, evaluating audit progress, reporting and work prioritization within cross functional teams

CERTIFICATIONS

Required

Certified Coding Specialist (CCS)/Certified Professional Coder (CPC) or
Certified Paralegal

Role/location

This is a full-time position for a Certified Coder/Auditor Audit Defense, based in either of our offices. Somerset, NJ or Fort Lauderdale, FL. Requires hybrid on-site at either location.

The primary responsibilities include conducting detailed audits, ensuring compliance with healthcare regulations, and performing accurate medical coding. Additional tasks involve working closely with healthcare providers to review documentation, resolve coding discrepancies, and ensure adherence to the relevant standards and best practices in coding and auditing.

Qualifications

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
Strong analytical skills with the ability to conduct detailed audits
Excellent communication and collaboration skills for working with diverse teams
Bachelor’s degree in a related field or relevant work experience is preferred
Familiarity with healthcare compliance guidelines and regulations is a plus
Hospitals and Health Care

EEO Statement:

CareCloud is committed to equal employment opportunity for all qualified individuals. We are committed to complying with all federal, state, and local laws providing equal employment opportunities,and all other employment laws and regulations. CareCloud prohibits discrimination against employees and applicants because of race, religion, color, gender (including gender or sexual identity or expression), age, national origin, ancestry, marital status, sexual orientation, physical or mental disability, medical condition including genetic characteristics, genetic information, veteran status, or other characteristics protected by applicable law.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. This position requires the ability to occasionally lift office products, equipment, and supplies, up to 20 pounds.

ADA Statement:

CareCloud is fully compliant with the ADA and will provide reasonable accommodations to enable individuals with disabilities to perform essential job functions under the guidance of the ADA.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that you may be asked by your managers to perform other duties.

Benefits:

CareCloud recognizes the importance of benefits and wellness for employees and their families. In addition to time off to support work-life balance and enjoyment, we offer a comprehensive benefits package designed for employees’ individual needs (including domestic partners).