Medical Coding Auditor - Compliance & Quality

Healthfirst; New York (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

Healthfirst is seeking a Coding Auditor to ensure accurate diagnostic coding for CMS, NYSDOH, and related entities, based on patient records and guidelines.

The role involves auditing data and medical records, identifying discrepancies, and collaborating with departments to improve coding practices and overall quality. The position supports continuous improvement and adheres to Healthfirst policies.

Qualifications

• Coding certification from AAPC/CPC or AHIMA.
• High school diploma or GED.
• Experience in health care coding and auditing preferred.

Responsibilities

• Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance.
• Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions.
• Evaluates the quality of medical coding 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 to improve processes across departments.
• Additional duties as assigned.

Skills

Time management

Critical thinking

Creative thinking

Communication

Problem-solving

Caseload management

Education

AAPC/CPC/AHIMA certification

High school diploma or GED

Tools

Outlook

Word

Excel

PowerPoint

Adobe Acrobat

Job description

Healthfirst is seeking a Coding Auditor to ensure accurate diagnostic coding for CMS, NYSDOH, and related entities, based on patient records and guidelines.

The role involves auditing data and medical records, identifying discrepancies, and collaborating with departments to improve coding practices and overall quality. The position supports continuous improvement and adheres to Healthfirst policies.