Coding Auditor & Educator for Value-Based Care

DaMar Staffing; Mundelein (IL); Presencial; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

WellMed Optum Florida seeks a Coding Auditor / Educator to conduct coding and documentation audits ensuring compliance with CMS and state regulations. You will lead prospective and retrospective audits focusing on risk adjustment, HCC capture, and E/M accuracy, while delivering targeted education to providers and coding staff across a 1,600-employee network.

You will collaborate with medical providers, clinical leadership, revenue cycle, and compliance teams to identify trends, prepare reports,

Formación

• CPC, CCS, CRC or equivalent coding certification.
• Minimum 3+ years of medical coding experience with at least 2 years in a coding audit or educator role.
• Demonstrated expertise in risk adjustment / HCC coding in a Medicare Advantage or value-based care setting.
• Strong knowledge of ICD-10-CM, CPT, CMS-HCC risk adjustment methodology, and E/M documentation guidelines.
• Experience with RADV audit preparation and chart review processes.
• Familiarity with CMS regulations, OIG compliance guidance, and FWA requirements.
• Excellent presentation and interpersonal skills with the ability to educate providers at all levels.
• Proficiency in EMR systems and audit tools.
• Ability to travel to clinic sites across Florida as needed.

Responsabilidades

• Audit provider documentation for ICD-10-CM accuracy, HCC capture, and E/M level selection.
• Monitor for upcoding, unbundling, and unsupported diagnoses.
• Audit encounters supporting RADV standards and chart reviews.
• Produce audit reports, findings, and corrective action recommendations.
• Identify coding trends and risk areas across clinics.
• Track corrective action plans to close deficiencies.
• Provide education on coding practices to providers and staff.
• Collaborate with clinical leadership to integrate coding education into quality initiatives.

Conocimientos

CPC/CCS/CRC

Medical coding

Risk adjustment

HCC coding

E/M guidelines

CMS/OIG regs

Training ability

EMR systems

Audit tools

Herramientas

EMR systems

Audit tools

Descripción del empleo

WellMed Optum Florida seeks a Coding Auditor / Educator to conduct coding and documentation audits ensuring compliance with CMS and state regulations. You will lead prospective and retrospective audits focusing on risk adjustment, HCC capture, and E/M accuracy, while delivering targeted education to providers and coding staff across a 1,600-employee network.

You will collaborate with medical providers, clinical leadership, revenue cycle, and compliance teams to identify trends, prepare reports,