Coding Audit Manager

Job not on LinkedIn

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Core Health LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🌍 Social Impact

Healthcare • Healthcare Insurance • Social Impact

Core Health LLC is a Health Services Management company specializing in managing at-risk patients, including the elderly, disabled, and those eligible for Medicaid and Medicare-Medicaid programs. The company collaborates with integrated health systems, Medicare Advantage Plans, and Accountable Care Organizations to enhance patient care in their communities. They also operate Health Alliance Connect, an integrated care program focused on seniors and individuals with disabilities.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• Equal opportunity employer • Compliance with ADA regulations as applicable