Lead Healthcare Audit & Coding Specialist

CareCloud; Pennsylvania; On-site; USD 90,000 - 115,000; Full time

Job summary

Empower Healthcare and Compliance Partners, a CareCloud subsidiary, seeks an Audit Defense Auditor/Coder to lead regulatory audits of coding teams and defend payor disputes. Your background includes payer audits, CMS guidelines knowledge, and strong coding expertise.

You will mentor staff, prepare final reports, and coordinate with Legal and Compliance on appeals. Minimum qualifications include CCS/CPC or paralegal certification, an associate degree in healthcare or related field, and 5+ years

Qualifications

• Background dealing with payor audits, legal defenses, appeals/denials
• Proficiency in Medical Coding and strong knowledge of Medical Terminology
• Experience with Coding Standards and familiarity with Health Information Management principles
• CPC/CCS certification or equivalent credentials
• Strong analytical skills with the ability to conduct detailed audits
• Excellent communication and collaboration skills for working with diverse teams
• Bachelor’s degree in a related field or relevant work experience preferred
• Familiarity with healthcare compliance guidelines and regulations is a plus

Responsibilities

• Background dealing with payor audits, legal defenses, appeals/denials
• Lead regulatory audits for coding teams.
• Ensure completion of projects to meet regulatory / departmental deadlines.
• 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 regarding Appeals of Regulatory Audit final determinations.
• Conduct data analyses from medical record reviews to identify opportunities to improve provider documentation and coding.

Skills

Audit defense

Medical Coding

Regulatory compliance

Data analysis

Communication

Education

Associate’s degree in healthcare, Clinical or Business Related

Job description

Empower Healthcare and Compliance Partners, a CareCloud subsidiary, seeks an Audit Defense Auditor/Coder to lead regulatory audits of coding teams and defend payor disputes. Your background includes payer audits, CMS guidelines knowledge, and strong coding expertise.

You will mentor staff, prepare final reports, and coordinate with Legal and Compliance on appeals. Minimum qualifications include CCS/CPC or paralegal certification, an associate degree in healthcare or related field, and 5+ years