Audit and Coding Specialist

About the role

The Audit and Coding Specialist plays a crucial role in Community Reach Center's Quality Improvement Division. They manage assigned projects, conduct audits, and support risk management activities.

Responsibilities

• Designs and implements internal compliance audits, monitoring accuracy and adherence to documentation requirements.
• Collaborates with Utilization Manager to implement, track, and monitor client outcomes for continuous quality improvement.
• Maintains knowledge of Colorado State laws, rules, and policies related to mental health licensure and clinical practices.
• Ensures clinical documentation aligns with internal policies, CMS, state, federal regulations, third-party payors, and AMA guidelines.
• Supports risk management activities and responds to external audits.
• Participates in response to external audits to ensure appropriate access to PHI and coordinates with Program Managers and other Managers and Directors.

Requirements

• Bachelor’s Degree or equivalent required.
• Two years minimum experience in healthcare auditing or utilization review.
• Certified Professional Coder or Certified Coding Specialist- Physician Based certification required.
• Certified Professional Medical Auditor (CPMA) and Certified Documentation Expert Outpatient (CDEO) certifications highly desirable.
• Strong professional knowledge of Microsoft Office Suite of Products, including PowerPoint.
• Effective communication, organization, time management, and clinical skills.
• Bilingual Spanish preferred.

Qualifications

• Experience in healthcare auditing or utilization review.
• Knowledge of Colorado State laws, rules, and policies related to mental health licensure and clinical practices.
• Ability to maintain knowledge of and certifications for Certified Professional Coder (CPC) or Certified Coding Specialist Physician Based (CCSP).
• Proficiency in Microsoft Office Suite of Products, particularly PowerPoint.
• Strong organizational and communication skills.
• Bilingual Spanish proficiency.

Skills

• Flexibility and adaptability.
• Reliability and commitment.
• Communication.
• Learning and self-development.
• Performance and KPI alignment.
• Code of Conduct and Employee Handbook compliance.
• Emotional intelligence.

Benefits

• Competitive compensation.
• 401K with matching.
• Wellness program.
• Health insurance reimbursement allocation.
• Shift differential pay when applicable.
• Bilingual stipend pay.
• 24/7 Employee Assistance Program.
• Opportunity for cross-licensure sponsorship if eligible.
• Tuition reimbursement.
• Loan forgiveness options including National Health Service Corps, Colorado Health Service Corps, and Public Student Loan Forgiveness.

Pay

$65,000 - $75,000/year

Schedule

M-F 8-5 with possible work from home 1-2 days/week. Quarterly travel through roadshow training of sites with mileage reimbursement opportunities. Occasional travel when supporting various annual audits.