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Compliance Coding Auditor

2 months ago

Washington, United States Medstar Full time

Position Overview
MedStar Family Choice is in search of a qualified Compliance Coding Auditor to enhance our DC Medicaid Plan team. The ideal candidate must hold a certification in Medical Coding and will be responsible for conducting audits and investigations to ensure adherence to relevant laws and regulations governing the Medicaid Program Integrity.

Key Responsibilities
- Conduct thorough audits of provider billing practices to identify discrepancies and ensure compliance with federal and District regulations.
- Analyze existing payment policies and propose enhancements to strengthen program integrity and operational processes.
- Prepare detailed audit reports and communicate findings to management, initiating corrective action plans as necessary.
- Manage responses to external inquiries and investigations, ensuring timely and accurate information is provided.
- Maintain confidentiality of sensitive provider and member information throughout the auditing process.

Qualifications
- High School Diploma or GED required; Bachelor's degree preferred.
- At least one coding credential is mandatory: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC).
- A minimum of four years of relevant experience, particularly in coding and documentation auditing within a healthcare or insurance setting.

Skills and Competencies
- Strong understanding of healthcare billing regulations and coding guidelines.
- Excellent organizational abilities with a capacity to manage multiple tasks efficiently.
- Proficiency in MS Office applications and familiarity with Medicaid and Medicare requirements.
- Exceptional verbal and written communication skills, with a focus on maintaining confidentiality and compliance with HIPAA regulations.

This position offers a competitive salary range and a comprehensive benefits package, promoting a healthy work-life balance.