Coding Audit Manager

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Review and evaluate denied claims associated with CPT, ICD-10-CM, and HCPCS coding and documentation issues.

• Supervise Core’s clinician auditors.

• Detect denial trends, underlying causes, and recurring denial patterns.

• Execute corrective measures to enhance coding accuracy and minimize future denials.

• Collaborate with billing, revenue cycle, coding, and clinical teams to resolve inconsistencies and appeal denials.

• Perform medical record audits to ensure coding accuracy, documentation support, and compliance with regulatory and payer standards.

• Create and uphold reports on denial volumes, reasons, financial impacts, trends, and outcomes.

• Convey findings and opportunities for improvement to leadership and operational teams.

• Monitor coding errors and identify educational needs and workflow enhancement opportunities for coders/providers.

• Assess the effectiveness of corrective actions and provide follow-up reports.

• Develop and maintain a payer-specific coding denial crosswalk.

• Track coding productivity and quality metrics, assess individual and team performance, identify workflow barriers, and optimize workload.

• Prepare and submit appeal letters with necessary documentation within payer-specific deadlines.

• Monitor appeals until resolution.

• Stay updated on coding guidelines, payer policies, and regulatory requirements.

• Ensure that coding and billing activities adhere to HIPAA and other relevant regulations.

• Accurately document denial and appeal activities.

• Generate reports on denial trends and appeal outcomes.

• Offer feedback, training, and coding best practices.

• Perform additional related duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent is mandatory.

• At least 6 years of experience in medical coding and billing, specifically focusing on denial management.

• Previous experience in supervising or leading a team is required.

• Familiarity with various payer guidelines, including those for Medicare and Medicaid.

• Certification as a Professional Coder (CPC), Certified Coding Specialist (CCS), or an equivalent certification is required.

• Preferred certifications include RHIA, CDI, CPC, CCS, and CCS-P.

• Comprehensive knowledge of medical coding and billing systems as well as regulatory requirements.

• Understanding of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.

• Strong organizational abilities and capacity to handle multiple tasks in a fast-paced environment.

• Capability to adjust, modify, and prioritize tasks while meeting strict deadlines.

• Excellent communication and interpersonal abilities.

• Strong analytical skills and capacity to work independently.

• Aptitude for learning proprietary software applications.

• Ability to collaborate across different geographic locations.

• Proficiency in managing competing priorities and working effectively in a dynamic environment.

🏝️ Benefits

• Equal opportunity employer.

• Compliance with ADA regulations as applicable.