Coding Auditor

Healthfirst; Tennessee; On-site; USD 61,000 - 100,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401k contributions

Life insurance

Job summary

Healthfirst seeks a Coding Auditor to perform quality audits of diagnostic codes submitted to CMS and NYSDOH, ensuring accuracy based on documentation in member medical records.

The role involves reviewing data, claims, and records for compliance, identifying discrepancies, and collaborating with departments to improve coding practices. A CPC/AHIMA/AAPC certification plus a high school diploma are required.

Qualifications

• Certified coder with AAPC/CPC/AHIMA credential.
• High school diploma or GED required.
• Experience with medical coding and ICD-10 terminology preferred.

Responsibilities

• Audits data, claim submissions, and member records for completeness and accuracy according to Healthfirst policy.
• Identifies patterns of under-performance and noncompliance and recommends resolutions.
• Evaluates coding quality 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 across departments.
• Performs additional duties as assigned.

Skills

Communication skills

Time management

Analytical thinking

Problem-solving

Attention to detail

Professional writing

Microsoft Office

ICD-10 knowledge

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.

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.