Healthfirst

Position Summary The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions. Duties & Responsibilities Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions Evaluates the quality of medical coding and notifies management of discrepancies, as needed. Conducts internal audits of medical record reviews performed by colleagues Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines Supports continuous improvement and quality initiatives to...

Healthfirst is seeking a Coding Auditor to ensure accurate diagnostic coding for CMS, NYSDOH, and related entities, based on patient records and guidelines. The role involves auditing data and medical records, identifying discrepancies, and collaborating with departments to improve coding practices and overall quality. The position supports continuous improvement and adheres to Healthfirst policies. #J-18808-Ljbffr

Position Summary The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions. Duties & Responsibilities Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions Evaluates the quality of medical coding and notifies management of discrepancies, as needed. Conducts internal audits of medical record reviews performed by colleagues Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines Supports continuous improvement and quality initiatives...

Position Summary The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions. Duties & Responsibilities Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions Evaluates the quality of medical coding and notifies management of discrepancies, as needed. Conducts internal audits of medical record reviews performed by colleagues Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines Supports continuous improvement and quality initiatives...