Medical Auditor

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

📋 Description

• Perform routine and targeted audits of medical coding to ensure adherence to CMS, payer, and organizational standards.

• Create and provide training and feedback to coders and healthcare providers to enhance documentation quality and coding precision.

• Support the preparation and response for both internal and external audits, including handling documentation requests and validation assessments.

• Keep audit tracking logs, productivity reports, and accuracy metrics in line with company policies.

• Examine medical records, claims data, and provider documentation to evaluate the correctness of ICD-10-CM, CPT, HCPCS, and modifier assignments.

• Detect coding inaccuracies, trends, and areas for improvement.

• Compile comprehensive audit reports with actionable insights.

• Remain updated on AAPC, AHIMA, CMS, and OIG guidelines, payer policy adjustments, and HCC model revisions.

• Adhere to HIPAA, privacy, and compliance regulations when managing patient data and audit documentation.

⛳️ Requirements

• Current AAPC (CPC) or AHIMA (CCS-P, CCS) certification.

• At least 3 years of experience in medical coding.

• A minimum of 1–2 years in a coding audit, quality assurance, or compliance role.

• Solid understanding of HCC / risk adjustment coding principles, clinical documentation improvement, and coding validation methods.

• Exceptional knowledge of medical terminology, anatomy, physiology, pathophysiology, disease progression, and pharmacology.

• Extensive experience with CPT, ICD-10-CM, HCPCS, and modifier assignments.

• Capability to work autonomously and maintain productivity in a remote environment.

• Strong communication and problem-solving abilities.

• Proficient in electronic health record systems, encoder/coding software, and Google tools.

• Reliable internet access and a dedicated, secure workspace.

🏝️ Benefits

• 100% covered health, dental, and vision premiums (including for families).

• Generous parental leave policy (4 months for birthing parents, 2 months for partners).

• 401(k) plan with company matching.

• Flexible paid time off and adaptable work schedule.

• Fully remote work opportunity.