Medical Coding Compliance Auditor

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

📋 Description

• Deliver auditing, compliance, education, consulting, project management, and report writing services to healthcare clients.

• Collaborate as part of an audit team to fulfill client projects while adhering to productivity, quality, and deadline standards.

• Access medical record documentation from client EMR systems.

• Evaluate medical records for chart content, coding accuracy, and adherence to documentation requirements.

• Utilize audit reporting tools to document findings and generate reports for quality assurance review and client delivery.

• Interpret and apply guidance from CMS, AMA, OIG, NCCI, third-party payers, and other regulatory bodies.

• Recognize trends in documentation, coding, billing, reimbursement, and compliance risks.

• Convey findings to clients and internal leadership.

• Formulate audit findings, compliance suggestions, and corrective action plans.

• Prepare and present audit outcomes, executive summaries, and compliance recommendations to providers, administrators, attorneys, and executive leadership.

• Conduct educational and training sessions for team members, providers, and clients.

• Act as a resource for providers on matters of documentation, coding, and compliance.

• Engage in quality assurance and peer review activities.

• Assist with audit tools, educational materials, methodologies, and compliance resources.

• Coordinate research and resources for client engagements and special projects.

• Support leadership in ensuring timely, in-scope, and on-budget project delivery.

• Aid in developing project scope, objectives, and stakeholder engagement.

• Build and sustain relationships with clients and stakeholders.

• Review quality assurance audit reports and execute necessary corrections and adjustments.

• Stay updated with healthcare auditing principles, regulatory compliance guidance, reimbursement methodologies, and payer requirements.

• Proficiently use Microsoft Office Suite and other audit-related technologies.

⛳️ Requirements

• High School Diploma is mandatory.

• Bachelor's degree is preferred.

• At least 3 years of experience in healthcare auditing, documentation review, compliance, regulatory, or related healthcare fields.

• Proficient in conducting thorough medical record reviews and assessing documentation requirements.

• Experienced in auditing professional coding across various specialties and service settings.

• Proven experience with healthcare regulatory guidelines, including teaching physician settings, incident-to billing, split/shared services, and payer requirements.

• Skilled in analyzing payer policies, regulatory guidance, and reimbursement requirements, translating findings into actionable recommendations.

• Experienced in developing audit findings, corrective action plans, and compliance recommendations.

• Competent in preparing written audit reports and presenting findings to providers, executives, compliance leadership, and other stakeholders.

• Experienced in delivering education to providers and staff regarding documentation, coding, and compliance requirements.

• Preferably experienced in working independently within a consulting or client-service environment.

• Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, healthcare reimbursement principles, and regulatory requirements.

• Ability to evaluate complex documentation scenarios and apply nuanced regulatory guidance to support defensible audit conclusions.

• Strong written communication skills, including audit report writing, corrective action planning, and executive-level communications.

• Capable of conveying complex compliance and regulatory information clearly and confidently in both individual and group settings.

• Ability to effectively facilitate provider education and training.

• Skilled in identifying trends, interpreting data, and formulating practical, risk-based recommendations.

• Strong organizational, planning, project management, problem-solving, and decision-making abilities.

• Capable of managing multiple priorities and projects in fast-paced environments while consistently meeting deadlines.

• Exceptional attention to detail in auditing, compliance reviews, and documentation analysis.

• Commitment to outstanding client service and relationship management.

• Demonstrated professionalism and executive presence when interacting with clients and stakeholders.

• Ability to promote teamwork and collaboration while maintaining a professional and positive demeanor.

• Familiarity with AI-powered auditing and compliance tools.

• Advanced proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) and related technologies.

• Ability to work independently with minimal supervision while achieving high productivity and quality outcomes.

• Certified Professional Medical Auditor (CPMA) is required.

• Certified Professional Coder (CPC) is required.

• Certification in Healthcare Compliance (CHC) is preferred.

• Certification as a Professional Compliance Officer (CPCO) is preferred.

• Certification as a Risk Adjustment Coder (CRC) is preferred.

• Registered Health Information Administrator (RHIA) certification is preferred.

• Registered Health Information Technician (RHIT) certification is preferred.

• Certification as an Outpatient Coder (COC) is preferred.

• Other healthcare auditing or compliance-related certifications are preferred.

🏝️ Benefits

• Fully remote work arrangement.

• Full-time employment.

• Support from a team recognized in the industry.

• Opportunity to advance a career in healthcare compliance and auditing.