Coding Auditor

Healthfirst; Pennsylvania; On-site; USD 61,000 - 89,000; Full time

Job summary

Healthfirst is seeking a Coding Auditor to perform quality audits of diagnostic codes submitted to CMS, NYSDOH, and other entities based on medical record documentation. You will audit data, claims, and member records for completeness and compliance, identify discrepancies, and collaborate with departments to enhance coding quality.

The role requires coding certification (AAPC/CPC/AHIMA) and a high school diploma, with opportunities to review colleagues' work and support ongoing quality

Qualifications

• Previous relevant experience
• Time management, critical 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
• Knowledge of ICD10 and anatomy and pathophysiology medical terminologies

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

Skills

Time management

Critical thinking

Creative thinking

Communication

Problem-solving

Electronic documentation

Assessment skills

Outlook

Word

Excel

PowerPoint

Adobe Acrobat

Education

Coding certification (AAPC/CPC/AHIMA)

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.

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

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

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.