Senior Coding Auditor

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Description

Position at GoHealth Urgent Care

Position:                            Senior Coding Auditor
Reports to:                        VP/Director of Internal Audit
 
 
Job Description: 
The Senior Coding Auditor is responsible for providing senior level leadership to the Coding Audit function which includes planning and conducting medical coding audits to evaluate compliance with regulatory guidelines.  The work will include performing and documenting audit test work, communicating audit issues to management, writing audit reports, and identifying and evaluating emerging areas of organizational risk. This individual will coordinate with both internal coding staff and external third-party consultants and report directly to the VP/Director of Internal Audit. 
 
Responsibilities:  
  • Develops and oversees annual program of compliance and coding audit work
  • Plans and directs audits in identified high-risk areas
  • Evaluates compliance with laws, regulations, policy and procedures, coding, and billing standards
  • Creates and implements standardized audit methodology
  • Oversees and manages correction action plan (“CAP”) processes
  • Assist with federal, state, and other special investigations and audits
  • Conducts investigations as requested
  • Support and provide coding and compliance training to coding staff, physicians, clinical personnel, billing, and/or other staff as needed
  • Encourage ongoing skill development by providing opportunities for continued education.
 
Qualifications:  
  • Associate level degree in business administration or health care related field, Certified Professional Coder (CPC) required. 
  •  BA/BS degree preferred. 
  • 5+ years of relevant experience in a professional audit capacity required 
  • 3+ years of experience managing a team preferred.
  • Strong technical knowledge of Institute of Internal Auditing (IIA) standards and Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding 
  • Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.
  • Excellent communication skills, both written and verbal to interact with varying levels of management and professional staff.
  • Strong analytical, problem-solving, and strategic thinking skills. 
 

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