Truhealth - Franklin, TN
posted about 2 months ago
Full-time - Mid Level
Franklin, TN
Amusement, Gambling, and Recreation Industries
About the position
The Coding and Medical Records Auditor at TruHealth LLC is responsible for conducting coding audits prior to claims submission to ensure accurate coding for each member of the health plan. This role involves reviewing medical records, assessing trends, and providing education to staff and providers. The auditor will also perform post-payment coding reviews and maintain compliance with regulatory standards.
Responsibilities
- Review claims prior to billing to ensure accuracy.
- Assess trends and communicate education to staff and organization.
- Review medical records and documentation to verify accuracy of diagnosis codes.
- Conduct pre-claim and post-claim coding audits to prevent claim denials.
- Work with claim processors to correct errors before payment.
- Assist with validation audits to ensure coding reflects medical documentation accurately.
- Complete assigned coding projects and maintain production and quality standards.
- Provide high-level customer service to internal and external customers.
- Escalate coding audit issues to management as necessary.
- Ensure compliance with Federal and State regulations.
Requirements
- 3 years of HCC coding and/or coding and billing experience required.
- 5 years of HCC coding and/or coding and billing experience preferred.
- 2+ years of complex claims processing and/or coding auditing experience in the health insurance industry recommended.
- 2+ years of experience in a managed healthcare environment related to claims and/or coding audits recommended.
- Knowledge of standard coding and reference materials such as CPT4, ICD10, HCPCS.
- Knowledge of CMS requirements regarding claims processing and coding, especially for Skilled Nursing Facilities.
- Experience coding/auditing claims for Medicare and Medicaid plans.
Nice-to-haves
- Experience in a managed healthcare environment related to coding audits.
- Complex claims processing and/or coding experience in the health insurance industry.
Benefits
- Health insurance
- 401k plan
- Paid time off
- Professional development opportunities
