Coding Auditor

Healthfirst; New York (NY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Healthfirst is seeking a Coding Auditor to ensure accurate diagnostic coding for CMS, NYSDOH, and related entities, based on patient records and guidelines.

The role involves auditing data and medical records, identifying discrepancies, and collaborating with departments to improve coding practices and overall quality. The position supports continuous improvement and adheres to Healthfirst policies.

Qualifications

• Coding certification from AAPC/CPC or AHIMA.
• High school diploma or GED.
• Experience in health care coding and auditing preferred.

Responsibilities

• Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance.
• Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions.
• Evaluates the quality of medical coding and notifies management of discrepancies.
• Conducts internal audits of medical record reviews performed by colleagues.
• Collaborates with other departments to improve coding compliance and clinical guidelines.
• Supports continuous improvement and quality initiatives to improve processes across departments.
• Additional duties as assigned.

Skills

Time management

Critical thinking

Creative thinking

Communication

Problem-solving

Caseload management

Education

AAPC/CPC/AHIMA certification

High school diploma or GED

Tools

Outlook

Word

Excel

PowerPoint

Adobe Acrobat

Job description

Position Summary

The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions.

Duties & Responsibilities

• Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure
• Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions
• Evaluates the quality of medical coding and notifies management of discrepancies, as needed.
• Conducts internal audits of medical record reviews performed by colleagues
• Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines
• Supports continuous improvement and quality initiatives to improve processes across departments.
• Additional duties as assigned

Minimum Qualifications

• Coding certification from either American Academy of Professional Coders (AAPC) or Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA).
• High school diploma or GED.

Preferred Qualifications

• Previous relevant experience
• Time management, critical/creative thinking, communication, and problem-solving skills
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Demonstrated professional writing, electronic documentation, and assessment skills.
• Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.
• Knowledge of ICD10 and anatomy and pathophysiology medical terminologies.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied.

Thank you for considering a career with HF Management Services, LLC.

Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 All Other Locations (within approved locations): $61,300 - $89,440

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).

Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering its nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well‑being. This value‑based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.