Strategic Medical Coding Auditor - Fraud & Compliance

South Florida Community Care Network Llc; Town of Florida (NY); Hybrid; USD 65,000 - 85,000; Full time

Job summary

South Florida Community Care Network, LLC in Sunrise, Florida is seeking a Medical Coding Auditor to conduct audits of pre- and post-payment records, ensuring compliant coding and identifying potential fraud, waste, abuse, and overpayments. The role requires maintaining documentation and regulatory adherence.

The position involves reviewing medical records, preparing summaries for committees, and generating reports; it supports a hybrid work schedule with duties spanning regulatory and contract

Qualifications

• Medical Coder certification from an accredited source is required.
• Experience in Medicaid claims or post payment coding auditing preferred.
• Knowledge of Medicaid rules, coding principles, and regulatory requirements.
• Familiarity with auditing, investigation and research methods.
• Proficiency with word processing, spreadsheets, and internet software.

Responsibilities

• Maintains a caseload of audit and appeals reviews with timely action.
• Performs pre- and post-payment medical record audits to identify potential FWA.
• Reviews appeal records and prepares summaries for the appeals committee.
• Generates audit notices, tracks responses, and reports findings.
• Documents audit steps and prepares reports or trends data.

Skills

Medical coding

Auditing

Fraud detection

Regulatory knowledge

Communication skills

Job description

South Florida Community Care Network, LLC in Sunrise, Florida is seeking a Medical Coding Auditor to conduct audits of pre- and post-payment records, ensuring compliant coding and identifying potential fraud, waste, abuse, and overpayments. The role requires maintaining documentation and regulatory adherence.

The position involves reviewing medical records, preparing summaries for committees, and generating reports; it supports a hybrid work schedule with duties spanning regulatory and contract