Senior Coding Auditor

Joining AdventHealth

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Benefits and Perks

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Job Description

Conduct pre-bill high-risk audits across inpatient and/or outpatient encounters targeting complex, high-acuity, and high impact cases. Performs advanced DRG validation, including MCC/CC integrity and clinical documentation alignment on inpatient audits. Reviews and validates appropriate application of ICD-10-CM/PCS or CPT/HCPCS and modifier usage, DRG/IPPS and/or OPPS/APC methodologies. Apply advanced expertise in ICD-10-CM/PCS and/or CPT/HCPCS, modifier usage, and/or DRG/IPPS and/or OPPS/APC methodologies. Partners with CDI, physicians, and coding teams to resolve complex documentation and coding scenarios prior to billing. Collaborates with CDI on Retrospective reviews to identify documentation and coding opportunities and improve accuracy. Performs and supports CloudMed DRG validation reviews and/or charge capture reviews, ensuring accurate representation of patient acuity and appropriate reimbursement. Supports and participates in coding and CDI escalation reviews, providing expert validation on complex cases. Identifies and escalates coding, regulatory, and denial risk trends, contributing to enterprise risk mitigation strategies. Provides detailed audit findings and supports development of targeted education based on high-risk audit results and regulatory updates. Tracks and reports on audit outcomes, risk exposure, and resolution of high-risk coding issues. Performs RAC and Commercial post payment audit rebuttals and outpatient denials. Performs other duties as assigned.

Knowledge, Skills, and Abilities

• Proficient experience with EMR and CAC systems (Epic and Optum preferred). [Required]
• Advanced knowledge of ICD-10-CM/PCS or CPT/HCPCS coding, DRG/IPPS methodology and/or APC/OPPS methodology [Required]
• Strong understanding of clinical documentation and acuity presentation [Required]
• Ability to interpret and apply regulatory guidance (CMS, OIG, NCCI, OPPS, IPPS) [Required]
• Ability to identify and mitigate coding and compliance risks [Required]
• Strong analytical and problem-solving skills [Required]
• Ability to translate audit findings into clear, actional feedback and targeted education [Required]
• Effective communication and cross functional collaboration skills [Required]
• Time management skills with the ability to work under pressure and meet deadlines [Required]
• Proficiency in Microsoft 365 office products [Required]

Education

• Associates degree [Required]
• Bachelors degree [Preferred]

Field of Study

• In a Healthcare related discipline

Work Experience

• 6 + years of acute care inpatient or outpatient hospital coding [Required]
• 4+ years of auditing experience [Required]

Additional Information

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Associates degree AND 6+ years of related work experience OR
• High School Grad or Equiv AND 8+ years of related work experience

Licenses and Certifications

• Certified Coding Specialist (CCS) [Required] OR Registered Health Information Administrator (RHIA) [Required] OR Registered Health Information Technician (RHIT) [Required] OR Certified Professional Coder (CPC) [Required] OR Certified Interventional Radiology Cardiovascular Coder (CIRCC) [Required]

Physical Requirements

Physical Requirements - https://tinyurl.com/23km2677

Pay Range

$66,830.40 - $124,300.80

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida's background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.