Medical Coding Auditor: Fraud & Compliance Specialist

Community Care Plan; Sunrise (FL); Hybrid; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Sunrise, Florida is seeking a Certified Medical Coder to conduct audits related to potential fraud, waste, and abuse. The role involves post-payment medical records reviews to ensure compliance with coding guidelines. Candidates must have medical coding certification and knowledge of Medicaid rules. The position offers a hybrid work schedule and requires strong analytical and communication skills.

Qualifications

• Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred.
• Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices.
• Knowledge of auditing, investigation, and research.

Responsibilities

• Conduct audits to identify potential fraud, waste, abuse, and/or overpayment.
• Maintain documentation of audits including coding guidelines and monetary discrepancies.
• Prepare written reports or trending data related to findings.

Skills

Written and verbal communication skills

Detail oriented

Analytical and critical thinking skills

Ability to organize and prioritize work

Education

Medical Coder certification from accredited source

Tools

Word processing software

Spreadsheet software

Internet software

Job description

A healthcare organization in Sunrise, Florida is seeking a Certified Medical Coder to conduct audits related to potential fraud, waste, and abuse. The role involves post-payment medical records reviews to ensure compliance with coding guidelines. Candidates must have medical coding certification and knowledge of Medicaid rules. The position offers a hybrid work schedule and requires strong analytical and communication skills.