Medical Auditor

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

📋 Description

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

• Create and provide educational resources and constructive feedback to coders and providers to enhance documentation quality and coding precision.

• Support internal and external audit preparations and responses, including managing documentation requests and conducting validation reviews.

• 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 accuracy of ICD-10-CM, CPT, HCPCS, and modifier assignments.

• Detect coding discrepancies, trends, and areas for enhancement; compile comprehensive audit reports containing actionable insights.

• Create and provide educational resources and constructive feedback to coders and providers to enhance documentation quality and coding precision.

• Support internal and external audit preparations and responses, including managing documentation requests and conducting validation reviews.

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

• Remain up-to-date with AAPC, AHIMA, CMS, and OIG guidelines, as well as changes in payer policies and HCC model updates.

• Adhere to all HIPAA, privacy, and compliance standards in managing patient data and audit documentation.

⛳️ Requirements

• Certification: Valid AAPC (CPC) or AHIMA (CCS-P, CCS) certification.

• Experience: At least 3 years of medical coding experience, including a minimum of 1-2 years in a coding audit, QA, or compliance role.

• Strong knowledge of HCC/risk adjustment coding principles, clinical documentation improvement, and coding validation practices.

• Excellent understanding of medical terminology, anatomy, physiology, pathophysiology, disease progression, and pharmacology.

• Extensive familiarity 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 with EHR systems, encoder/coding software, and Google applications.

• Reliable internet connection and a dedicated, secure workspace.

🏝️ Benefits

• 100% covered health, dental, and vision premiums (including family coverage)

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

• 401(k) plan with company match

• Unlimited PTO and a flexible work schedule