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 improve processes across departments.
Additional duties as assigned
Minimum Qualifications
Coding certification from either American Academy of Professional Coders (AAPC) or Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA).
High school diploma or GED.
Preferred Qualifications:
Previous relevant experience
Time management, critical/creative thinking, communication, and problem-solving skills
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
Demonstrated professional writing, electronic documentation, and assessment skills.
Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.
Knowledge of ICD10 and anatomy and pathophysiology medical terminologies.
Hiring Range*
Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620
All Other Locations (within approved locations): $61,300 - $89,440
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
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