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 Insurance
Paid Time Off from Day One
403-B Retirement Plan
4 Weeks 100% Paid Parental Leave
Career Development
Whole Person Well-being Resources
Mental Health Resources and Support
Pet 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 cases
Performs advanced DRG validation, including MCC/CC integrity and clinical documentation alignment on inpatient audits
Reviews and validates appropriate application of ICD-10-CM/PCS or CPT/HCPCS and modifier usage, DRG/IPPS and/or OPPS/APC methodologies
Apply advanced expertise in ICD-10-CM/PCS and/or CPT/HCPCS, modifier usage, and/or DRG/IPPS and/or OPPS/APC methodologies
Partners with CDI, physicians, and coding teams to resolve complex documentation and coding scenarios prior to billing
Collaborates with CDI on Retrospective reviews to identify documentation and coding opportunities and improve accuracy
Performs and supports CloudMed DRG validation reviews and/or charge capture reviews, ensuring accurate representation of patient acuity and appropriate reimbursement
Supports and participates in coding and CDI escalation reviews, providing expert validation on complex cases
Identifies and escalates coding, regulatory, and denial risk trends, contributing to enterprise risk mitigation strategies
Provides detailed audit findings and supports development of targeted education based on high-risk audit results and regulatory updates
Tracks and reports on audit outcomes, risk exposure, and resolution of high-risk coding issues
Performs RAC and Commercial post payment audit rebuttals and outpatient denials
Performs 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 OR
High School Grad or Equiv AND 8+ years of related work experience
Licenses and Certifications:
Certified Coding Specialist (CCS) [Required] OR Registered Health Information…