Senior Director of Coding Compliance & Audit

Essen Health Care; New York (NY); Hybride; USD 120 000 - 150 000; Plein temps

Résumé du poste

Essen Health Care in New York seeks a Director of CodingCompliance to lead coding compliance and audit activities across health plan operations, risk adjustment, payer audits and regulatory requirements. The role ensures accurate medical coding and documentation integrity.

The ideal candidate has CPC certification, 7–10 years in medical coding and compliance auditing, plus 5+ years in a health plan or payer environment.

Qualifications

• Certified CPC certification required.
• 7–10 years of medical coding and compliance auditing experience.
• 5+ years of experience within a health plan, managed care organization, or payer environment.
• Strong knowledge of CMS regulations, Medicare Advantage, NYS Medicaid, HEDIS, and risk adjustment methodologies.
• Extensive experience with ICD-10-CM, CPT, and HCPCS coding systems.
• Knowledge of healthcare compliance standards and regulatory requirements.
• Experience conducting coding audits and developing corrective action plans.

Responsabilités

• Conduct complex coding audits and documentation reviews for accuracy, completeness, and regulatory compliance.
• Review ICD-10-CM, CPT, HCPCS, and risk adjustment coding to ensure alignment with CMS and payer guidelines.
• Identify coding trends, compliance risks, and opportunities for operational improvement.
• Partner with Compliance, SIU, Clinical Operations, Provider Education, and RCM teams to support organizational initiatives.
• Develop and deliver provider and staff education related to coding accuracy and compliance standards.
• Monitor regulatory changes and communicate impacts to leadership and operational teams.
• Assist with internal and external audit preparation, corrective action plans, and regulatory responses.
• Support oversight activities related to FWA (Fraud, Waste, and Abuse) prevention and documentation integrity.
• Analyze audit findings and prepare detailed reports, dashboards, and executive summaries.
• Serve as a subject matter expert for coding compliance and regulatory requirements.

Connaissances

Regulatory compliance

Medical coding

Auditing

Leadership

Data analysis

Formation

Bachelor's degree in Health Information Management or related field

CPC certification

Outils

Microsoft Office Suite

Description du poste

Essen Health Care in New York seeks a Director of CodingCompliance to lead coding compliance and audit activities across health plan operations, risk adjustment, payer audits and regulatory requirements. The role ensures accurate medical coding and documentation integrity.

The ideal candidate has CPC certification, 7–10 years in medical coding and compliance auditing, plus 5+ years in a health plan or payer environment.