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Coding Auditor
Healthfirst • Remote, US • published 2026-09-20 22:55:05.024092
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Position Summary The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions.**Duties \& Responsibilities**: * Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure * Identifies patterns of under\-performance, noncompliance, and inconsistencies and recommends resolutions * Evaluates the quality of medical coding and notifies management of discrepancies, as needed. * Conducts internal audits of medical record reviews performed by colleagues * Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines * Supports continuous improvement and quality initiatives to improve processes across departments. * Additional duties as assigned **Minimum Qualifications:** * Coding certification from either American Academy of Professional Coders (AAPC) or Certified ...
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