Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess and enhance the quality, precision, compliance, and uniformity of coding executed by both internal and outsourced coding vendors spanning ASC, Professional Fee, Hospital Outpatient, and forthcoming coding initiatives.

• Conduct routine and focused audits of both internal and outsourced coding vendors.

• Execute pre-bill, post-bill, targeted, and retrospective audits.

• Analyze coding accuracy, modifier application, sequencing, documentation support, and compliance.

• Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, CMS, NCCI, payer guidelines, and organizational standards.

• Verify documentation and medical necessity.

• Track coding quality and identify trends.

• Assist in the development of scorecards and corrective action plans.

• Facilitate internal/external audits and ensure regulatory compliance.

• Offer education and feedback to coders.

• Collaborate with Revenue Integrity, HIM, Compliance, CDI, and Operations teams.

• Create audit reports, dashboards, and trend analyses.

• Suggest process enhancements and uphold coding policies.

• Act as a subject matter expert in coding, providing audit feedback and education under the supervision of the Coding Vendor Manager.

• Support facility and vendor meetings, audits, and organizational projects.

⛳️ Requirements

• Extensive knowledge of ICD-10-CM/PCS, CPT, HCPCS, CMS, NCCI, ASC, Hospital Outpatient, and Professional Fee coding.

• Excellent analytical, communication, auditing, and documentation review capabilities.

• Proficiency with encoder systems, EHRs, auditing software, Excel, and Microsoft Office applications.

• Bachelor's degree is preferred, or equivalent professional experience.

• At least 5 years of coding experience.

• Minimum of 3 years in coding audit experience.

• Experience auditing ASC, Hospital Outpatient, and Professional Fee coding.

• Vendor auditing experience is preferred.

• Preferred certifications include CCS, CPC, CCS-P, RHIA, and/or RHIT.

• CPMA certification is a plus.

• Capability to adhere to relevant coding standards, payer requirements, and regulatory guidelines.

• Successful completion of pre-employment screening, including criminal background checks and drug testing.

🏝️ Benefits

• Reasonable accommodations available for applicants with disabilities.

• Occasional travel required to support facility and vendor meetings, audits, and organizational initiatives.

• Commitment to equal opportunity employment and workforce diversity.

• Pre-employment screening including criminal background checks and drug testing.