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NeueHealth is a value-driven healthcare company transforming healthcare delivery by aligning the interests of health consumers, providers, and payors. The company operates owned clinics (Centrum Health and Premier Medical) and partnerships with affiliated providers, serving populations across ACA Marketplace, Medicare, and Medicaid.
The Manager of Medical Auditing oversees all coding audit activities across NeueHealth and Centrum Medical Holdings, ensuring accuracy, documentation integrity, and regulatory compliance in diagnosis and procedural coding. This role directs auditing practices for both wholly owned and non-wholly-owned Centrum-affiliated centers, integrating health plan feedback from external audits, conducting internal audit reconciliations, and collaborating with Compliance, Legal, and external vendors.
Key responsibilities include:
**Audit Operations & Oversight:**
- Perform prospective, concurrent, and retrospective coding audits across wholly owned and affiliated medical centers
- Audit the full scope of coding: ICD-10-CM diagnosis, CPT/HCPCS procedural, E/M leveling, and HCC/risk-adjustment capture
- Validate provider documentation supports all reported codes using accepted standards (e.g., MEAT)
- Reconcile internal audit results against external health plan and vendor audit findings
- Establish and maintain audit sampling methodologies, accuracy thresholds, and error-rate benchmarks
**Compliance & Regulatory Integrity:**
- Ensure coding practices comply with CMS, state Medicaid, HHS/CMS risk-adjustment, and commercial payer requirements
- Proactively monitor OIG work plans, CMS transmittals, coding-model updates, and payer bulletins
- Adjust audit protocols to reflect regulatory changes (e.g., CMS-HCC V28, RxHCC, HHS-HCC updates)
**Education & Collaboration:**
- Guide, educate, and train coders, providers, and clinical staff
- Convert audit findings into actionable feedback and sustainable performance improvements
- Partner closely with Manager of Medical Coding to align audit findings with coding operations and education
- Collaborate with Manager of Revenue Cycle Management to connect audit outcomes to charge capture, claims accuracy, and reimbursement integrity
**Analytics & Reporting:**
- Build and deliver audit workbooks, trackers, dashboards, and executive-facing presentations using advanced Excel and PowerPoint
- Track audit results and trends over time
- Provide enterprise-wide visibility into coding compliance and performance
This position carries enterprise-wide auditing responsibility and operates cross-functionally across wholly owned and affiliated centers, spanning Medicare Advantage, ACA/Exchange, and Medicaid lines of business.
