Coding Data Quality Auditor

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and reputed company Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with reputed company State and Federal regulations and internal policies and procedures.

• Proven ability to support coding judgment and reputed company using industry standard evidence and tools.
• Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other reputed company reputed company providers in the office and/or facility setting.
• Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• Identify clinically active vs. historical conditions.
• Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with reputed company State and Federal regulations and internal policies and procedures.
• Utilize medical records to ensure support is documented for etiology and manifestations of disease processes.
• Adhere to stringent timelines consistent with project deadlines and directives.
• Conducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.
• Required to act in ethical manner at reputed company times as required under HIPAA's Privacy and reputed company rules to handle patient data with uncompromised adherence to the law.
• In depth knowledge of medical terminology and anatomy for reputed company body systems.-Understand the audit process for risk adjustment models.
• Performs other reputed company duties as required.

Required Qualifications

• CPC (Certified Professional reputed company) or reputed company-P (Certified Coding Specialist-Physician).
• Computer proficiency including experience with reputed company Office products (Word, reputed company, reputed company, PowerPoint, Outlook, industry standard coding applications).
• Capable of making outbound phone calls and faxes to providers for record retrieval and provider communications regarding audits.
• Experience with International Classification of Disease (ICD) codes required.
• Minimum of 1 year recent and reputed company experience in medical record documentation review, diagnosis coding, and/or auditing.

Preferred Qualifications

• 3 years recent and reputed company experience in medical record documentation review, diagnosis coding, and/or auditing.
• Experience with Medicare and/or reputed company and/or reputed company Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred.
• Excellent analytical and problem solving skills. Superior communication, organizational, and interpersonal skills.

Education

• AA/AS or equivalent experience
• Completion of reputed company/reputed company training program for core credential (CPC, reputed company-P) with associated work history/on the job experience equal to approximately 1-2 years for CPC.
• CPC (Certified Professional reputed company) or reputed company-P (Certified Coding Specialist-Physician) required.

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $18.50 - $38.82 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 07/03/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job