Coding Auditor

Elevance Health•Durham, NC

1d•Remote

About The Position

Coding Auditor CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. This is a virtual eligible role. You should be within a reasonable proximity to one of our offices. HOURS: 8:00a - 5:00p, Monday through Friday (Eastern or Central time) Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires a H.S. diploma or equivalent and minimum of 1 year of experience as a coder of medical records in a physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background.
Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.

Nice To Haves

Previous auditing experience is a must for this role!
BS in health sciences, health management or related field preferred.
CRC certification preferred.

Responsibilities

Responsible for auditing diagnosis data collected from physician and hospital medical records to ensure proper ICD9 coding and compliance with risk adjustment requirements.
Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
Provides regular feedback to Operations leadership on performance improvement opportunities as a result of performance gaps.
Participates in and represents the department in business leadership groups.
Assesses and identifies training opportunities.
Assists the business with research and documentation of workflows, policies and procedures and other materials.
Maintains current knowledge of requirements and guidance required in the performance of audit duties.
Reviews medical records that have been reviewed and coded by the coding vendor.