Coding Auditor
Centrum Health
Posted on 3/15/2023
Miami, FL, USA
Experience Level
  • Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes
  • What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative
  • If you share our passion for changing healthcare so all people can live healthy, brighter lives - apply to join our team
  • Current coding certification through AAPC (CPC) or AHIMA (CCS)
  • Current coding auditor certification (AAPC) for at least 2 years
  • Minimum of 5 years overall coding experience with a minimum of 3 years in Risk Adjustment
  • 2 to 3 years in risk adjustment with multiple models (ACA, Medicare, Medicaid, and Commercial) and mapping
  • 3 + years of healthcare revenue cycle management, billing, and collection-related work experience. General understanding of professional fee billing processes and procedures
  • Current knowledge of coding guidelines and current CPT, ICD-10, and HCPCS coding, fee schedule reimbursement methodology, and regulatory requirements for provider coding and reimbursement
  • Working knowledge of key coding concepts, such as CPT modifiers, surgical packages, medical record documentation requirements, and multiple procedure guidelines. Proficient in analyzing statical data
  • Bilingual: English and Spanish
  • Strong knowledge on medical terminology, medical abbreviations, pharmacology, and disease processes
  • Deep expertise in finding coding resources and answering specific coding questions
  • Monitors, and evaluates work performed by coders; reports any issues to the Coding Manager
  • Monitors and reports medical record documentation to identify potential issues. Reports unusual and complex issues. Recommends action plans and suggests processes for improvements
  • Works with Coding Manager to establish, implement, and maintain a formalized review process for coding and documentation compliance. Monitors and adheres to the audit schedule. Analyzes audit results, identifies trends, and presents audit/review findings, potential issues, and their root causes to ensure audit results are disseminated and understood. Provide education based on audit findings
  • Participates in educational activities to maintain current credentials, as well as enhance knowledge and skills. Attends department staff meetings and aids other departments as requested by managemen
  • Special Projects
  • The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer
  • Travel will be required to Medical Centers office (70%). This is not a work at home position
Bright Health

1,001-5,000 employees

Affordable personalized health insurance
Company Overview
Bright Health's mission is to make healthcare right. They believe quality health insurance should be simple, personal, and affordable. So they design easy-to-understand plans with benefits you'll actually use. Benefit-packed plans and surprisingly low rates mean you can focus on staying happy and healthy.
  • Compensation and retirement - Performance bonus, Stock Options, 401k plan, 401k matching, Commuter assistance plans
  • Health and wellness - Health insurance, Dental insurance, Vision insurance, Life insurance, Disability insurance, FSA (Flexible Spending Plan), EAP (Employee Assistance Program)
  • Vacation and time off - Unlimited time off, Paid holidays, Flexible working hours, Maternity benefits, Paternity benefits
  • Values and quality of life - Public Transportation, Bike parking, Employee groups and committees, Snacks and beverages
Company Core Values
  • Be brave - Challenge the status quo with curiosity, courage, and tenacity
  • Be brilliant - Deliver predictable excellence with a learning mindset
  • Be accountable - Live by your word, always
  • Be inclusive - Value all voices and contributions to achieve big things
  • Be collaborative - Fearlessly partner with all people