Medical Coding Auditor

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

📋 Description

• Verify and ensure the precision, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions.

• Confirm the correct assignment of diagnosis and procedure codes, adhering to all relevant coding guidelines.

• Utilize electronic tools (such as spreadsheets and web-based applications) that have been developed based on the CMS-HCC model and established coding standards.

• Draft written summaries detailing audit findings.

• Deliver verbal feedback on audits and provide education following the completion of the medical record audit.

• Address or clarify internal information requests.

• Support and engage in process and quality improvement initiatives.

• Collaborate with business associates from various departments to comprehend their needs and concerns, and assist in developing system solutions.

• Understand departmental, segment, and organizational strategies and operational goals, including their connections to related areas.

• Make decisions regarding work methods, sometimes in ambiguous situations, requiring minimal direction while seeking guidance when necessary.

• Adhere to established guidelines and procedures.

⛳️ Requirements

• This role necessitates both a CPMA and CRC certification.

• At least one of the following certifications from AAPC or AHIMA is required: CPC - Certified Professional Coder (AAPC), CCS - Certified Coding Specialist (AHIMA), or CCS-P - Certified Coding Specialist-Physician Based (AHIMA).

• A minimum of two years of outpatient coding experience is required, preferably in a risk adjustment setting.

• Familiarity with various reimbursement methodologies, including risk adjustment and fee-for-service models.

• Must fulfill annual continuing education obligations and remain in good standing with the certification governing body.

• Proficient in all Microsoft Office applications, including Word and Excel.

• Strong public speaking and group presentation skills.

• Willingness to travel locally and overnight within Conviva and CenterWell markets as required by business needs.

🏝️ Benefits

• Medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off, including company and personal holidays, volunteer time off, and paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance.