South Florida Community Care Network LLC

Job Description Job Description Position Summary: The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through pre and post payment medical records review and appeal 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, coverage policies and regulatory and contract requirements. Qualifications:  Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required. Prior experience in Medicaid claims role and/or post payment medical coding auditor role preferred. Knowledge of Medicaid rules, claims processing, medical terminology and coding principles and practices. Knowledge of auditing, investigation, and research. Knowledge of...

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 #J-18808-Ljbffr