Coding Auditor - 251978
Healthcare Audit and Coding Specialist ( MUST LIVE IN NY STATE) Schedule: Monday – Friday | 9:00 AM – 5:00 PM Employment Type: Full-Time Position Summary We are seeking a detail-oriented and experienced Healthcare Audit and Coding Specialist to support audit operations, coding compliance, and payment integrity initiatives. This role is responsible for managing ongoing audit workflows, identifying areas of risk, conducting coding reviews, and ensuring accurate reimbursement practices across healthcare services. The ideal candidate will have strong expertise in medical coding, claims analysis, audit processes, and provider education, with the ability to identify discrepancies, improve compliance, and support organizational goals related to cost containment and payment accuracy.
Key Responsibilities
- Manage and execute ongoing audit workflows, ensuring timely completion and high levels of accuracy
- Identify new audit opportunities through data analysis, trend monitoring, and risk-based reviews
- Develop and implement audit protocols for new areas of focus
- Analyze claims data to detect discrepancies, patterns, and potential compliance risks
- Conduct manual reviews and audits to ensure proper coding and reimbursement practices
- Partner with internal teams to report potential fraud, waste, or abuse and escalate findings as needed
- Track, validate, and report on key performance metrics related to audit and payment accuracy functions
- Collaborate cross-functionally to support audit operations and process improvement initiatives
- Provide education and feedback to providers to improve coding accuracy and compliance
- Stay current on coding guidelines, reimbursement methodologies, and industry best practices
- Participate in special projects, trainings, and continuous improvement efforts
Required Qualifications
- Bachelor’s degree in Healthcare Administration, Business, Health Informatics, or a related field (or equivalent combination of education and experience)
- Active coding certification required (CPC, CCS, CIC, COC, or similar)
- Minimum of 3 years of experience in medical coding within a professional healthcare setting
- Minimum of 3 years of experience in auditing, compliance review, or payment integrity within healthcare
- Strong understanding of coding standards and provider reimbursement methodologies
- Familiarity with health insurance structures and various plan types
- Strong analytical skills with exceptional attention to detail
- Ability to identify trends, solve problems, and make data-driven recommendations
- Experience educating providers or stakeholders on coding and compliance best practices
- Strong communication, collaboration, and interpersonal skills
Preferred Qualifications
- Advanced experience in healthcare auditing and compliance programs
- Strong knowledge of fraud, waste, and abuse detection processes
- Experience working with payer-side audit functions or managed care organizations
- Background in performance metric reporting and audit process improvement initiatives
Why Join Us? This is an excellent opportunity for a coding and audit professional who is passionate about healthcare compliance, payment integrity, and improving operational excellence. Join a collaborative team where your expertise directly impacts quality, accuracy, and healthcare outcomes. Apply tot his job Apply To this Job