Location 1240 39th Street,Brooklyn, NY, 11218,United States
Base Pay $83,000.00 - $90,000.00 / Year
Employee Type Full Time
Required Degree 4 Year Degree
We are seeking a detail-oriented and experienced Coder Auditor to join our dynamic team. The ideal candidate will be responsible for ensuring the accuracy and completeness of clinical data used to support risk adjustment coding for our Medicare plan. You will work closely with healthcare providers and clinical teams to identify and mitigate documentation gaps, ultimately supporting our mission to provide exceptional care to our members.
Responsibilities
Audit and QC the coding team’s output for accuracy and compliance with HCC/ICD-10-CM guidelines
Speak directly with providers — writing and following up on provider queries for insufficient or ambiguous documentation
Educate providers on documentation practices that support accurate risk adjustment coding
Serve as the escalation point for complex charts and coding questions from the coding team
Track error patterns and trends in coding quality and report on them
Be able to work independently as a senior-level resource
Be comfortable owning second-level review
Strong knowledge of HCC hierarchy, RAF methodology, and CMS risk adjustment guidelines required
Specific Knowledge, Skills, and Abilities
Ability to read and interpret documents, identify areas of coding gaps. Ability to speak effectively with physicians and employees of the agency.
Ability to identify areas of over or under utilization and work with team and physician groups to develop processes to avoid
Ability to work with team on development of processes for right-coding, appropriate utilization, and closing gaps in care
Required Education, Experience, and Licenses
CRC certification required
Managed Care/Medicare Advantage experience required, dual‑eligible or FIDE‑SNP experience a plus
At least 3 years’ satisfactory experience in Managed Care, desired.
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