Senior Coding Auditor

Our Promise To You Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability InsurancePaid Time Off from Day One403-B Retirement Plan4 Weeks 100% Paid Parental LeaveCareer DevelopmentWhole Person Well-being ResourcesMental Health Resources and SupportPet Benefits Schedule Full time Shift Day (United States of America) Address 900 HOPE WAY City ALTAMONTE SPRINGS State Florida Postal Code 32714 Job Description Conduct pre-bill high-risk audits across inpatient and/or outpatient encounters targeting complex, high-acuity, and high impact casesPerforms advanced DRG validation, including MCC/CC integrity and clinical documentation alignment on inpatient auditsReviews and validates appropriate application of ICD-10-CM/PCS or CPT/HCPCS and modifier usage, DRG/IPPS and/or OPPS/APC methodologiesApply advanced expertise in ICD-10-CM/PCS and/or CPT/HCPCS, modifier usage, and/or DRG/IPPS and/or OPPS/APC methodologiesPartners with CDI, physicians, and coding teams to resolve complex documentation and coding scenarios prior to billingCollaborates with CDI on Retrospective reviews to identify documentation and coding opportunities and improve accuracyPerforms and supports CloudMed DRG validation reviews and/or charge capture reviews, ensuring accurate representation of patient acuity and appropriate reimbursementSupports and participates in coding and CDI escalation reviews, providing expert validation on complex casesIdentifies and escalates coding, regulatory, and denial risk trends, contributing to enterprise risk mitigation strategiesProvides detailed audit findings and supports development of targeted education based on high-risk audit results and regulatory updatesTracks and reports on audit outcomes, risk exposure, and resolution of high-risk coding issuesPerforms RAC and Commercial post payment audit rebuttals and outpatient denialsPerforms other duties as assigned Knowledge, Skills, And Abilities Proficient experience with EMR and CAC systems (Epic and Optum preferred). [Required]Advanced knowledge of ICD-10-CM/PCS or CPT/HCPCS coding, DRG/IPPS methodology and/or APC/OPPS methodology [Required]Strong understanding of clinical documentation and acuity presentation [Required]Ability to interpret and apply regulatory guidance (CMS, OIG, NCCI, OPPS, IPPS) [Required]Ability to identify and mitigate coding and compliance risks [Required]Strong analytical and problem-solving skills [Required]Ability to translate audit findings into clear, actional feedback and targeted education [Required]Effective communication and cross functional collaboration skills [Required]Time management skills with the ability to work under pressure and meet deadlines [Required]Proficiency in Microsoft 365 office products [Required] Education Associates degree [Required]Bachelors degree [Preferred] Field Of Study In a Healthcare related discipline Work Experience 6 + years of acute care inpatient or outpatient hospital coding [Required]4+ years of auditing experience [Required] Additional Information An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:Associates degree AND 6+ years of related work experience ORHigh School Grad or Equiv AND 8+ years of related work experience Licenses And Certifications Certified Coding Specialist (CCS) [Required] OR Registered Health Information Administrator (RHIA) [Required] OR Registered Health Information Technician (RHIT) [Required] OR Certified Professional Coder (CPC) [Required] OR Certified Interventional Radiology Cardiovascular Coder (CIRCC) [Required] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677 Pay Range $66,830.40 - $124,300.80 Background Screening Requirement (Florida Law) Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/ This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.