Clinical Coding & Compliance Lead

MCS Puerto Rico; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Puerto Rico seeks an Operations Supervisor for CHRA units, retrospective projects, and clinical coding processes. You will ensure compliance with procedures across accrediting bodies, including Medicare, and oversee post-payment audits and coding review cycles.

Responsibilities include coordinating audits, generating performance reports, guiding staff, and implementing process improvements while maintaining adherence to policies and regulatory requirements.

Qualifications

• Bachelor’s degree in health-related areas and 4+ years in extraction of diagnoses/procedures and medical record interpretation.
• Associate degree in Health Information Management Technology or 60 credits with 4+ years in diagnostic coding and staff supervision.
• Certification in clinical coding (CCA/CCS/CCS-P) preferred; knowledge of ICD-10-CM, CPT-4, HCPCS.
• English and Spanish proficiency; willingness to communicate in both languages.

Responsibilities

• Oversees CHRA post-payment audit processes and timing.
• Ensures second-level coding audits are completed on schedule.
• Monitors referral processes and ensures timely completion of referrals.
• Reviews coding audit results and ensures corrective actions are implemented.
• Identifies risks and coordinates with IT for system fixes as needed.
• Prepares and delivers statistical reports related to the Scorecard within the established time.
• Supervises unit staff and enforces company policies and compliance.

Skills

Staff supervision

Process improvement

Auditing

Healthcare compliance

IT coordination

Education

Bachelor’s degree in health-related areas

Associate degree in Health Information Management Technology

Tools

Microsoft Office

PowerPoint

Excel

Word

Outlook

Job description

MCS Puerto Rico seeks an Operations Supervisor for CHRA units, retrospective projects, and clinical coding processes. You will ensure compliance with procedures across accrediting bodies, including Medicare, and oversee post-payment audits and coding review cycles.

Responsibilities include coordinating audits, generating performance reports, guiding staff, and implementing process improvements while maintaining adherence to policies and regulatory requirements.