Hybrid Audit Defense Auditor & Medical Coding Specialist

CareCloud; Fort Lauderdale (FL); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Empower Healthcare and Compliance Partners (Empower HCP), a subsidiary of CareCloud, seeks an Audit Defense Auditor/Coder to lead detailed medical record audits for regulatory and payer audits, ensuring accurate coding and documentation while interfacing with clients and staff.

This full-time role requires CCS/CPC or paralegal certification, 5 years of clinical documentation auditing experience, and 3 years of payer-side audit experience. Hybrid work, based in Somerset, NJ or Fort Lauderdale, FL.

Qualifications

• Associate’s degree in healthcare, clinical or business related.
• 5 years’ experience with clinical documentation auditing and 1 year in audit defense or
• 3 years of payer-side audit experience including medical record review, coding validation, and CMS guideline application.
• CPC/CCS or Paralegal certification required or equivalent.

Responsibilities

• Lead regulatory audits for coding teams.
• Ensure completion of projects to meet regulatory / departmental deadlines.
• Provide business and/or subject matter expertise for regulatory audits.
• Mentor audit coding teams to ensure deliverables.
• Ensure audit compliance with CMS Coding Guidelines and Payer Coding Guidelines.
• Review and analyze weekly reports to ensure quality review performance.
• Prepare final audit reports per exact specifications for Audit Defense or Client Audit.
• Assist Legal with Appeals of Regulatory Audit final determinations.
• Interface with Compliance and Legal for Appeals of Regulatory Audit final determinations.
• Conduct data analyses from medical record reviews to identify opportunities to improve provider documentation and coding.
• Interface with client revenue programs for provider education teams to identify educational opportunities.
• Participate in all Regulatory Audit training and monitor publications to update processes.
• Other duties as assigned or requested.

Skills

Medical Coding proficiency

Medical Terminology

Analytical skills

Communication skills

Regulatory compliance knowledge

Education

Associate’s degree in healthcare, Clinical or Business Related

Bachelor’s degree preferred

Job description

Empower Healthcare and Compliance Partners (Empower HCP), a subsidiary of CareCloud, seeks an Audit Defense Auditor/Coder to lead detailed medical record audits for regulatory and payer audits, ensuring accurate coding and documentation while interfacing with clients and staff.

This full-time role requires CCS/CPC or paralegal certification, 5 years of clinical documentation auditing experience, and 3 years of payer-side audit experience. Hybrid work, based in Somerset, NJ or Fort Lauderdale, FL.