Community Care Plan

A healthcare organization in Sunrise, Florida is seeking a Certified Medical Coder to conduct audits related to potential fraud, waste, and abuse. The role involves post-payment medical records reviews to ensure compliance with coding guidelines. Candidates must have medical coding certification and knowledge of Medicaid rules. The position offers a hybrid work schedule and requires strong analytical and communication skills. #J-18808-Ljbffr

Overview Certified Medical Coder required (AHIMA, AAPC, or PMI). Hybrid-Sunrise, Florida The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements. Essential Duties and Responsibilities Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment. Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified. Coordinates overpayment recoveries with the Fraud Investigative Unit Manager. Responsible for assisting the Fraud Investigative...