Senior Medical Coding & Audit Lead

Group Health, Inc (Parent); New York (NY); Remote; USD 120,000 - 160,000; Full time

Job summary

Group Health, Inc (Parent) in New York seeks a senior clinical coding leader to direct coding review standards across authorizations, claims review, grievances and new medical policy implementation.

You will oversee insourcing plans, maintain analytics and ensure compliance while coordinating with Legal, Compliance and utilization management. Requires CCS/CPC, RN/LPN license, 5–8+ years coding, and leadership experience.

Qualifications

• Bachelor's degree in healthcare/business/quantitative science preferred.
• CCS or CPC certification required.
• Active RN or LPN license required.
• Clinical Documentation Reviewer certification required.

Responsibilities

• Direct coding review standards for authorizations, claims review, grievances and new policy implementation.
• Ensure quality and productivity of appeals and coder work queues.
• Develop plans to insource coding reviews from vendors.
• Manage responses to audits and inquiries by external agencies.
• Support analyses for Special Investigations Unit and Legal Department.
• Develop guidelines for coding and documentation to ensure compliance.
• Present findings to senior management and external parties.
• Train staff entering the department in coding and analysis.

Skills

Analytical skills

Organization

MS Office

Multi-tasking

Verbal communication

Written communication

Education

Bachelor's degree

CCS (AHIMA) or CPC (AAPC)

RN or LPN license

Clinical Documentation Reviewer certification

Tools

Word

Excel

Access

PowerPoint

Outlook

Job description

Group Health, Inc (Parent) in New York seeks a senior clinical coding leader to direct coding review standards across authorizations, claims review, grievances and new medical policy implementation.

You will oversee insourcing plans, maintain analytics and ensure compliance while coordinating with Legal, Compliance and utilization management. Requires CCS/CPC, RN/LPN license, 5–8+ years coding, and leadership experience.