RADV and Pre-Audit Specialist: Clinical Coding

MCS Health; San Juan (PR); On-site; USD 52,000 - 74,000; Full time

Job summary

MCS Healthcare Holdings, LLC is seeking an experienced auditor to perform RADV and internal audits of Independent Contractors and Providers in Puerto Rico. The role involves educational outreach, documenting audit results, and ensuring compliance with coding guidelines.

The candidate should have a health-related degree, 1+ year of auditing experience, and relevant coding certifications. A valid Puerto Rico driver’s license and willingness to travel across locations are required.

Qualifications

• Bachelor's degree in health-related fields required or equivalent experience.
• At least 1 year of audits in diagnosis coding, medical records review, clinical information extraction, medical terminology, and risk identification.
• Certifications: CCA, CCS, CCS-P or Medical Billing preferred.
• Puerto Rico driver's license required.
• Must have own vehicle to move between locations in Puerto Rico.

Responsibilities

• Perform RADV audits according to the work plan for internal and external clients.
• Identify opportunities to reduce audit risk and improve coding compliance.
• Communicate with providers and IPA administrations about inquiries and best practices.
• Develop and deliver presentations to IPA Administrators and providers.
• Document audit results and maintain updated audit records.

Skills

Auditing

Medical coding

Medical records review

Risk identification

Communication

Spanish

English

Education

Bachelor's Degree in Health-related fields

CCA

CCS

CCS-P

Medical Billing Certification

Driver's License (Puerto Rico)

Tools

N/A

Job description

MCS Healthcare Holdings, LLC is seeking an experienced auditor to perform RADV and internal audits of Independent Contractors and Providers in Puerto Rico. The role involves educational outreach, documenting audit results, and ensuring compliance with coding guidelines.

The candidate should have a health-related degree, 1+ year of auditing experience, and relevant coding certifications. A valid Puerto Rico driver’s license and willingness to travel across locations are required.