Surgery Coding Auditor

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

📋 Description

• Conduct independent audits of surgical and procedural coding to ensure accuracy, documentation support, compliance, and reimbursement implications.

• Assess assignments related to ICD-10-CM, CPT, HCPCS Level II, modifiers, global packages, and Correct Coding Initiative bundling.

• Detect incorrect, missing, unbundled, upcoded, downcoded, unsupported, or otherwise non-compliant codes and modifiers.

• Examine diagnoses and procedures within the electronic health record and approved audit tools while adhering to established sampling requirements.

• Document findings with supporting authority, financial implications, risk assessments, and suggested corrective actions.

• Maintain an audit accuracy rate of no less than 95 percent and engage in calibration processes.

• Assist in the development of audit work plans, collection tools, facility reports, consolidated reports, and progress updates.

• Discuss preliminary findings with HIMS leadership, the COR, management, and designated facility staff.

• Prepare or assist in final reports addressing accuracy, documentation concerns, financial implications, process improvements, and educational needs.

• Create and present facility-specific coding education based on actual findings and a train-the-trainer model when tasked.

• Support exit conferences by explaining coding findings, recommendations, and authoritative guidance.

• Safeguard VA information while adhering to privacy, information security, encryption, and remote-work protocols.

• Adhere to assigned audit schedules, reporting deadlines, training obligations, credential requirements, and access protocols.

⛳️ Requirements

• Must be a U.S. citizen.

• Proficiency in English; capable of reading, writing, speaking, and understanding the language.

• Possession of an active RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H credential.

• Minimum of two years of coding experience in the relevant coding domain.

• At least three years of consulting experience reviewing records in large tertiary-care hospitals and outpatient organizations that provide primary care and subspecialty services.

• Minimum of three years of experience in education and training.

• Expertise in ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, DRG, modifiers, bundling, reimbursement, documentation, and compliance regulations.

• Successful completion of the Low Risk NACI background process.

• Fulfillment of required VA privacy, information security, and mandatory training.

• Ability to work securely within the United States.

• Maintain a minimum audit accuracy of 95 percent.

• Capability to meet reporting and turnaround timelines.

• Submission of a current resume, signed Letter of Intent, and completed candidate cover page.

• Evidence of an active accepted AHIMA or AAPC credential.

• Two current client references pertinent to the individual reviewer.

• Results of OIG exclusion search and any requested background, security, identification, privacy, training, or onboarding documents.

🏝️ Benefits

• Competitive salaries and benefits packages.