New

Clinical Coding Auditor

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Mar 17, 2025
Responsible for overseeing and coordinating clinical coding audits within a healthcare organization. This position plays a vital role in ensuring the accuracy and compliance of medical coding practices to support proper reimbursement, data quality, and regulatory requirements. Does this position require Patient Care? No Essential Functions -Develop and implement a coding audit plan to assess the accuracy and compliance of clinical coding practices. -Identify priority areas for audit based on risk analysis, regulatory changes, and coding performance data. -Coordinate and conduct coding audits for inpatient, outpatient, and specialty services to evaluate coding accuracy and completeness. -Review medical records, encounter documentation, and coding assignments to verify proper code assignment. -Ensure coding practices align with relevant coding guidelines, including ICD-10-CM, CPT, HCPCS, and other coding systems. -Monitor coding compliance with coding regulations and payer requirements. Education Bachelor's Degree Can this role accept experience in lieu of a degree? Yes Licenses and Credentials Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) required Experience At least 5-7 years of coding audits experience in a healthcare setting Knowledge, Skills, and Abilities Significant experience in clinical coding and coding audits in a healthcare setting. In-depth knowledge of ICD-10-CM, CPT, HCPCS, and other coding systems and guidelines. Familiarity with coding compliance and regulatory requirements. Strong analytical and problem-solving skills. Excellent communication and interpersonal abilities. Attention to detail and accuracy in coding audit processes. Proficiency in using coding software and electronic health record (EHR) systems. Ability to work independently and as part of a team. Working Conditions: This is a remote role that can be done from most US states. Local employees attend meetings 1x/month in the office. Physical Requirements Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.