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Coding Auditor or Coding Auditor Sr.

Company Name:
UniCare Life & Health Insurance Company
Job Description
WellPoint is one of the nations leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
_Coding Auditor or Coding Auditor Sr._
Responsible for auditing diagnosis data collected from physician and hospital medical records to ensure proper ICD9 coding and compliance with risk adjustment requirements.
This position may be filled at either the Auditor or Auditor Sr. level. Manager will determine level based upon the selected applicants skillset relative to the qualifications listed for this position.
Coding Auditor
Primary duties may include, but are not limited to:
Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
Provides regular feedback to Operations leadership on performance improvement opportunities as a result of performance gaps.
Participates in and represents the department in business leadership groups.
Assesses and identifies training opportunities.
Assists the business with research and documentation of workflows, policies and procedures and other materials.
Maintains current knowledge of requirements and guidance required in the performance of audit duties.
Reviews medical records that have been reviewed and coded by the coding vendor.
Coding Auditor, Sr
Primary duties may include, but are not limited to:
Audits diagnosis data retrieved from physician and hospital medical records and/or data extract files for both revenue project and RADV.
Assists with National and Targeted Risk Adjustment Data Validation audits.
Participates and represents the department in business leadership groups.
Serves as a subject matter exert.
Assesses and identifies training opportunities.
Maintains current knowledge of requirements and guidance required in the performance of audit duties.
Job Qualifications
Coding Auditor
Requires a high school diploma; 1 year of experience as a coder of medical records in a physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background. BS in health sciences, health management or related field preferred. Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.
Coding Auditor Sr.
Requires a high school diploma; 3 years of experience as coder of medical records in physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background. BS in health sciences, health management or related field preferred. Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required. Experience working with Medicare Advantage preferred. Experience with ICD-9 coding a plus. HCC coding preferred.
_WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at
Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

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