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Coding Compliance Specialist

1 month ago

San Francisco, California, United States GoHealth Urgent Care Full time
Job Description:

The Coding Auditor at GoHealth Urgent Care is responsible for conducting medical coding audits to evaluate compliance with regulatory guidelines.

The work involves performing and documenting audit test work, communicating audit issues to management, writing audit reports, and identifying emerging areas of organizational risk.

These individuals may coordinate with external third-party consultants as needed and report directly to the Coding Audit Manager.

Responsibilities:

  • Conducts coding, billing, and documentation compliance audits within established timeframe and in accordance with the standards defined by GoHealth
  • Prepares a report of findings and recommendations for improvement for each audit
  • Serves as a subject matter expert on coding/billing topics
  • Researches issues/questions and responds to internal inquiries
  • Assists the Provider Educators with developing a detailed audit plan for the area being reviewed
  • Meets audit productivity standards
  • Meets annual requirements to maintain coding certification.

Qualifications:
Education

  • Associate level degree in business administration or a healthcare-related field, Certified Professional Coder (CPC) required
  • BA/BS degree preferred
Work Experience

  • 3+ years of relevant experience in a professional audit capacity required
  • 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