Coding Auditor Senior

Elevance Health•Tampa, MO

6d•Remote

About The Position

The Coding Auditor Senior audits diagnosis data collected from physician and hospital medical records and/or data extract files to ensure proper ICD-9/ICD-10 coding and compliance with risk adjustment requirements. The role supports revenue projects and Risk Adjustment Data Validation (RADV) audits, serves as a subject matter expert, and helps identify training opportunities. The position may be based at any PulsePoint office, with St. Louis, Missouri preferred. It is primarily virtual full-time, with required in-person training sessions; candidates may need to reside within commuting distance of an office under the company’s hybrid/virtual work policy.

Requirements

High school diploma or equivalent, or an equivalent combination of education and experience.
At least 3 years of experience coding medical records in a physician office, hospital, or insurance/coding office setting, or an equivalent combination of education and experience.
Medical Coder certification from an accredited source, such as the American Health Information Management Association, American Academy of Professional Coders, or Practice Management Institute.

Nice To Haves

Bachelor of Science in health sciences, health management, or a related field.
Experience working with Medicare Advantage.
Experience with ICD-9 coding.
HCC coding experience.
Strong communication skills.

Responsibilities

Audit diagnosis data retrieved from physician and hospital medical records and/or data extract files for revenue projects and RADV.
Assist with National and Targeted Risk Adjustment Data Validation audits.
Participate in and represent the department in business leadership groups.
Serve as a subject matter expert.
Assess and identify training opportunities.
Maintain current knowledge of requirements and guidance needed to perform audit duties.