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Coding and Compliance Auditor

Integrated Resources, Inc Boston Contractor
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Job Title: Coding and Compliance Auditor
Job Location: Charlestown, MA 02129
Job Duration: 4+ Months (starts in Aug)
•         The Coding & Compliance Auditor performs complex operational and financial audits of provider claims using established work processes and job aides.
•         The Auditor also mentors less experienced staff.
•         Extensive knowledge of claim processing and policies is required.
•         This position also requires a working knowledge of medical terminology and coding skills to evaluate accuracy of charges according to reimbursement policies, and industry standard billing and coding guidelines as adopted.
Key Functions/Responsibilities:
•         Demonstrates expert knowledge and understanding of benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations as well as industry standards for claim adjudication.
•         Performs operational and financial audits of provider claims to identify issues with system configuration, provider contracts, claims operations, provider billing accuracy, and other party liability processes.
•         Adjudicates claims following established recovery guidelines and job aides.
•         Identifies potential recovery projects and reports findings to management.
•         Remains current with claims adjudication processes and internal and external software systems, including Facets, CAD, and Ingenix/Code Manager.
•         Achieves department production, quality requirements and individual financial recovery goals.
•         Ensures multiple audit projects are completed within designated audit deadlines.
•         Participates in special projects and initiatives.
•         Assists in developing/revising departmental policies and procedures.
•         Attends and participates in team meetings.
•         Mentors and coaches less experienced staff and new hires.
  • Bachelor’s Degree in Healthcare Administration, business related field or an equivalent.
  • Combination of education, training and experience is required.
  • Intermediate knowledge of medical terminology, CPT, ICD9, HCPCS coding
  • CPC or CCS certification a plus. Experience:
  • 2 or more years’ experience in a progressive role within healthcare or managed care field required.
  • 3 or more years’ experience as a claims analyst required.
  • Working knowledge of Facets claim processing system preferred.
  • Prior Auditing and/or Medical Record review experience desired.
Certification or Conditions of Employment:  
  • Strong oral and written communication skills.
  • Ability to interact within all levels of the department.
  • A strong working knowledge of Microsoft Office products.
  • Detail oriented, excellent proof reading and editing skills.
  • Sensitive provider customer service skills.
  • Must be able to multi-task, prioritize projects and work well with deadlines.
  • Must be able to be flexible and willing to perform all necessary and appropriate duties to ensure the attainment of departmental and organizational goals.
Working Conditions and Physical Effort:
  • Regular and reliable attendance is an essential function of the position.
  • Work is normally performed in a typical interior/office work environment.
  • No or very limited physical effort required. No or very limited exposure to physical risk.

Recommended skills

Managed Care
Healthcare Common Procedure Coding Systems
Cpt Coding
Claim Processing


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Coding and Compliance Auditor
Estimated Salary: $73K
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Job ID: 19-12485


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