Medical Coding Auditor
PacificSource Health Plans(25 days ago)
About this role
The Medical Coding Auditor at PacificSource researches and resolves grievances and appeals within the commercial line of business, applying clinical interpretation and advanced adjudication expertise. The role supports development of claims research policies, process improvement, and recovery efforts for erroneous or potentially fraudulent payments. The position collaborates across departments and contributes to audit, quality, and compliance initiatives.
Required Skills
- Medical Coding
- Claims Adjudication
- Clinical Evaluation
- Coding Research
- Audit Procedures
- Compliance
- Fraud Detection
- Medical Records
- Project Management
- Data Analysis
+2 more
Qualifications
- High School Diploma or Equivalent
- Certified Professional Coder (CPC) - Preferred (to be obtained within 1 year)
About PacificSource Health Plans
pacificsource.comPacificSource offers health insurance plans for individuals, families, and employers. A Northwest not-for-profit, we put members first.
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