Senior Billing & Coding Compliance Auditor

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.

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.