Coding Audit Manager

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🕒 Outubro 9

⚜️ Louisiana – Remoto

⚜️ Louisiana – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 17%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 33 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

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Core Health LLC

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

🌍 Impacto Social

Healthcare • Healthcare Insurance • Social Impact

A Core Health LLC é uma empresa de Gestão de Serviços de Saúde especializada no gerenciamento de pacientes de risco: idosos, pessoas com deficiência, beneficiários do Medicaid e duplamente elegíveis do Medicare-Medicaid. Colaboramos com sistemas de saúde integrados, Planos Advantage do Medicare e Organizações de Atendimento Responsável para melhorar o cuidado ao paciente nas comunidades em que atuamos.

Descrição

• Review and analyze denied claims related to CPT, ICD-10-CM, and HCPCS coding and documentation issues • Oversee Core’s clinician auditors • Identify denial trends, root causes, and recurring denial patterns • Implement corrective actions to improve coding accuracy and reduce future denials • Collaborate with billing, revenue cycle, coding, and clinical teams to resolve discrepancies and appeal denials • Conduct medical-record audits for coding accuracy, documentation support, and regulatory and payer compliance • Develop and maintain reporting on denial volumes, reasons, financial impact, trends, and outcomes • Communicate findings and improvement opportunities to leadership and operational teams • Track coding errors and identify coder/provider education and workflow improvement opportunities • Monitor corrective-action effectiveness and provide follow-up reporting • Develop and maintain a payer-specific coding denial crosswalk • Monitor coding productivity and quality metrics, individual and team performance, workflow barriers, and workload optimization • Prepare and submit appeal letters with supporting documentation within payer-specific timeframes • Track appeals through resolution • Maintain current knowledge of coding guidelines, payer policies, and regulatory requirements • Ensure coding and billing activities comply with HIPAA and other relevant regulations • Document denial and appeal activities accurately • Generate denial-trend and appeal-outcome reports • Provide feedback, training, and coding best practices • Perform other related duties as assigned

🎯 Requisitos

• Bachelor’s degree or equivalent is required • Minimum of 6 years of experience in medical coding and billing, with a focus on denial management • Prior experience supervising or leading a team • Familiarity with various payer guidelines, including Medicare and Medicaid • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required • Preferred: RHIA, CDI, CPC, CCS, CCS-P • Knowledge and understanding of medical coding and billing systems and regulatory requirements • Knowledge of legal, regulatory and policy compliance issues related to medical coding and billing procedures and documentation • Strong organizational skills and ability to multi-task in a fast-paced environment • Ability to adapt, modify and prioritize while adhering to strict deadlines • Excellent communication and interpersonal skills • Strong analytical skills and ability to work independently • Ability to learn proprietary software applications • Ability to collaborate across geographic locations • Ability to navigate competing priorities and work effectively in a fast-paced environment

🏖️ Benefícios

• Equal opportunity employer • Compliance with ADA regulations as applicable

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