Senior Pre-Audit & Coding Quality Manager

MCS Puerto Rico; San Juan (PR); On-site; USD 80,000 - 100,000; Full time

Job summary

MCS Puerto Rico is seeking an experienced professional to guarantee timely internal and external audits of Independent Contractors and Providers within the unit’s program. You will monitor the work plan for clinical coding audits and supervise personnel across operational areas, guiding improvements to risk areas identified by CMS risk adjustment audits.

The role requires a Bachelor’s degree in healthcare administration or related field, at least five years of audit experience, and supervisory

Qualifications

• Bachelor’s degree in Healthcare Administration or related field with at least 5 years auditing diagnosis coding.
• Experience supervising personnel and reviewing medical records.
• Certification in Medical Billing, CPC, or CCS preferred.

Responsibilities

• Develops and updates annually the work plan for audits of internal coding team and contractors.
• Oversees clinical coding audits and evaluates results to design improvement strategies.
• Guides Providers, IPAs, and Medical Office Billing Representatives on coding practices and documentation.
• Ensures procedures and records for audits and corrective actions are up to date.
• Monitors implementation of action plans and improvement efforts identified in audits.
• Prepares and submits reports to management on audit findings per the work plan.

Skills

Audits

Staff supervision

Medical coding audits

SOX controls

Education

Bachelor’s degree in Healthcare Administration

Bachelor’s degree in Business Administration

Job description

MCS Puerto Rico is seeking an experienced professional to guarantee timely internal and external audits of Independent Contractors and Providers within the unit’s program. You will monitor the work plan for clinical coding audits and supervise personnel across operational areas, guiding improvements to risk areas identified by CMS risk adjustment audits.

The role requires a Bachelor’s degree in healthcare administration or related field, at least five years of audit experience, and supervisory