RADV Audit & Clinical Coding Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 65,000 - 85,000; Full time

Job summary

MCS Puerto Rico is seeking a detail-oriented RADV audits specialist to perform internal and external audits of Independent Contractors and Providers, ensuring compliance with documentation and clinical coding rules.

The role involves visiting physician offices, delivering trainings, communicating with IPA administrations, and reporting findings to management while staying current with CMS/AHIMA/AMA guidelines.

Qualifications

• Bachelor's degree in health-related area.
• At least 1 year of audit experience performing diagnosis coding, medical records review, and risk identification.
• Certifications such as CCA/CCS/CCS-P or Medical Billing preferred. A valid driver's license.

Responsibilities

• Perform clinical coding and RADV audits according to the work plan.
• Identify opportunities to reduce audit risk and educate providers or IPA administrators.
• Communicate with providers and IPA administrations regarding inquiries on coding and documentation.
• Develop and deliver presentations to IPA Administrators and providers.
• Evaluate referrals to guide providers on documentation and coding rules.
• Document audit results and keep updated records.
• Advise clients on audit findings and implement improvement plans.
• Report audits to management and participate in educational plans.
• Stay up to date with coding guidelines from CMS, AHIMA and AMA.

Skills

Auditing

Medical records review

Clinical coding knowledge

Communication skills

Education delivery

Education

Bachelor's degree in health-related field

Job description

MCS Puerto Rico is seeking a detail-oriented RADV audits specialist to perform internal and external audits of Independent Contractors and Providers, ensuring compliance with documentation and clinical coding rules.

The role involves visiting physician offices, delivering trainings, communicating with IPA administrations, and reporting findings to management while staying current with CMS/AHIMA/AMA guidelines.