Job Address:

Medical Coding and Billing Compliance Auditor

Location: Remote Department: Coding Compliance Reports To: Director of Coding Employment Type: Full-time Exempt

About the Role

The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation integrity and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. The Medical Coding Auditor will have a background in Physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have an extensive background and knowledge of CPT coding, ICD10CM coding, E&M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access Medicare Physician Fee Schedule (MPFS) tools including status indicators and what they mean, National Correct Coding Initiative (NCCI) manual and edits, Local and National Coverage Determinations (LCD and NCD), Coding Clinic, and CPT assistant. The ideal candidate will have knowledge of Skilled Nursing Facility (SNF) E&M coding, Behavior Health coding, telehealth coding rules, HCC payment methodologies, and other specialty coding.

Key Responsibilities

• Performs Coding audits for compliance and accuracy with all coding systems outlined in the role description.
• Completes coding compliance accuracy score tracking, trending, and monitoring.
• Completes detailed coding compliance reports which include feedback and education for providers.
• Maintains excellent documentation of all reviews, methodologies employed, results, escalation needed, and monitoring.
• Provide feedback and education to billers, coders, and providers on documentation and coding practices.
• Identify trends, errors, and compliance risks, and recommend corrective actions.
• Stay current on changes to coding guidelines, payer policies, and regulatory requirements.
• Collaborate with compliance, revenue cycle, and clinical teams to support audit outcomes.
• Assist with internal and external audit requests as needed.

Qualifications

Required:

• Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in Health Information Management or related field preferred.
• Certification: Current coding credential required (CPC, CEMC, CCS-P, RHIT, RHIA).
• Experience: 3+ years of outpatient coding experience required. 1+ years of audit, compliance, or quality review experienceStrong understanding of ICD-10-CM, CPT, E&M, HCC, HCPCS, and official coding guidelines.
• Experience with EMR/EHR systems, encoders, and auditing tools.

Preferred:

• Additional auditing certification (CPMA, CEMA, CDEO) preferred
• Leadership skills/experience

Skills & Competencies:

• Exceptional attention to detail and accuracy.
• Analytical Skills.
• Strong organizational skills.
• Strong written and verbal communication skills.
• Provider Education skills.
• Demonstrated ability to use technology and applications required for virtual teams.
• Ability to analyze data, identify trends, and recommend solutions.
• Knowledge of HIPAA, OIG, and other compliance regulations.
• Ability to work independently and manage multiple priorities.
• Performance Metrics
• Audit accuracy rate (goal ≥ 95%).
• Timeliness of audit completion/productivity
• Provider and coder education effectiveness (measured by post-education improvement).
• Compliance with CMS and ICD-10-CM guidelines.