Medical Coding and Billing Auditor

About the role

Triple‑S is seeking a Medical Coding and Billing Auditor to ensure accurate coding, compliance, and optimal reimbursement for its healthcare services across Puerto Rico. You will work closely with risk adjusters, billers, providers, and compliance teams to identify and correct discrepancies.

Key responsibilities

• Audit medical records, billing data, and coding documentation for errors and compliance with payer and regulatory guidelines.
• Evaluate and correct coding for CPT, HCPCS, ICD‑10, and risk adjustments, and submit changes in the system of record.
• Prepare detailed audit reports, summaries, and action plans for management review.
• Identify documentation gaps, trends, and escalation needs with providers, coordinators, and billers.
• Provide training and feedback to physicians, medical office staff, and billers based on audit findings.
• Collaborate on the development and maintenance of coding policies and procedures.

Required profile

• Bachelor’s degree in Business Administration, Health Administration, or a related field.
• Minimum two years of experience in medical coding, billing, or audit functions, preferably in an outpatient setting.
• Certified Professional Coder (CPC) credential.

Required skills

• Proficiency with CPT, HCPCS, and ICD‑10 coding systems.
• Knowledge of Medicare, Medicaid, and other payer regulations.
• Ability to conduct regular and random audits of coded records.
• Strong analytical and reporting skills.