What are the responsibilities and job description for the Senior Medical Billing & Coding Auditor position at NeueHealth?
The Senior Billing & Coding Compliance Auditor is a key player in ensuring the highest standards of clinical care and compliance for patients through advanced coding oversight, audits and quality assurance. This role serves as the primary coding contact for complex compliance issues, accuracy assessments, and identifies potential coding opportunities. This role reports to compliance and provides independent evaluation and oversite of billing/coding operational teams.
This is an onsite position at our headquarters in Doral.
DUTIES & RESPONSIBILITIES
- Lead and participate in advanced risk adjustment coding audits for all lines of business for coding completeness and accuracy
- Scheduling and coordinating with provider offices to review records and attain EMR access
- Perform and review complex code abstraction and coding quality audits of medical records to ensure appropriate ICD-10-CM code assignment and clinical documentation support.
- Identify, track, and implement documentation improvements, participating in and leading documentation improvement initiatives.
- Maintain all necessary coding certifications and stay current with ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines.
- Ensure compliance with all federal rules and regulations, guiding the team in adherence to coding standards.
- Respond to complex coding questions submitted and provide expert guidance and support.
- Teach and provide feedback to coding team, enhancing their skills and knowledge.
- Work with compliance officer to conduct strategic planning and continuous improvement initiatives to enhance coding accuracy and efficiency.
- Other duties and responsibilities as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
- Associate degree or bachelor’s degree preferred.
- Five or more years of experience in billing/coding and risk adjustment.
- Coding Certification requirements: CPC or CCDS required, CRC preferred.
- Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines.
- Extensive knowledge of Commercial and Medicare Advantage HCC models, including experience with RADV audits in Medicare/ACA populations
- Proficient in Microsoft Office Products; Word, Excel, PowerPoint.
PROFESSIONAL COMPETENCIES
- Strong written and verbal communication skills with the ability to convey complex information clearly.
- Exceptional attention to detail and analytical skills.
- Extensive knowledge of EMR systems, medical record review, and abstraction.
- Ability to quickly learn and adapt to meet evolving business needs.
- Ability to work independently and lead a team effectively.
- Strong relationship-building skills with office staff, physicians, and market teams.
- Advanced problem-solving abilities and strategic thinking skills.
