WellMed Optum Florida
Palm Bay, FL
ABOUT THE ROLE The Coding Auditor / Educator is responsible for conducting coding and documentation audits to evaluate compliance with federal and state regulations, payer requirements, and organizational policies. As a member of the Legal & Compliance Department, this individual contributor role supports the effectiveness of the organization’s compliance program by identifying coding risks, monitoring documentation accuracy, validating reimbursement integrity, and recommending corrective actions.
This role ensures accurate risk adjustment coding, HCC capture, and E/M documentation in a full-risk, value-based care environment. The position supports compliance with CMS-HCC risk adjustment guidelines, OIG audit expectations, and RADV preparedness. Working closely with providers, clinical leadership, revenue cycle, population health, and compliance teams, the Coding Auditor / Educator performs retrospective and prospective audits, analyzes coding trends, supports regulatory...