Coding Auditor

Job Title: Coding Auditor
Location: First 90 days onsite then 2 days remote, 3 days onsite
Comp: $30-32/hr
Benefits: For eligible employees, we offer medical, dental, vision, and 401K.

Required Qualifications

• 3+ Years in as a Coding Auditor OR E/M Auditing

• Active coding certification required: CPC, RHIT, or CCS-P

• Strong working knowledge of E/M coding guidelines, including 992 series codes

• Demonstrated expertise in ICD-10-CM diagnosis coding, including principal diagnosis selection and sequencing

• In-depth understanding of CMS regulations, payer guidelines, and compliance standards

• Experience auditing professional and/or facility medical records

Essential Skills & Knowledge

• Strong understanding of medical terminology, ICD-10-CM, CPT, and E/M coding guidelines

• Excellent analytical, critical thinking, and investigative skills

• High attention to detail and accuracy

• Strong written and verbal communication skills for reporting and provider education

• Ability to work independently and manage multiple audits in a fast-paced environment

Key Responsibilities
Medical Record Review

• Review provider documentation to ensure completeness, accuracy, and compliance with regulatory and payer requirements

• Validate that documentation supports medical necessity, level of service, and coding selection

E/M Coding Validation

• Audit Evaluation and Management services, including 99201–99215 and applicable facility-based E/M codes

• Validate appropriate code selection based on documented history, exam, medical decision making, or time, per current CMS and AMA guidelines

• Ensure provider supporting documentation substantiates the reported E/M level

Coding & Billing Audits

• Verify ICD-10-CM principal and secondary diagnoses for accuracy, sequencing, and clinical relevance

• Validate CPT and HCPCS coding against provider documentation

• Identify and flag potential upcoding, undercoding, unbundling, or documentation gaps

Compliance & Risk Identification

• Ensure compliance with CMS, payer-specific, and state regulations

• Identify potential fraud, waste, abuse, or compliance risks

• Support internal and external audit readiness initiatives

Reporting & Recommendations

• Prepare detailed audit reports outlining findings, trends, risk areas, and financial impact

• Recommend corrective actions, process improvements, and documentation enhancements

Provider & Staff Education

• Educate providers, coders, and operational staff on E/M documentation standards, ICD-10 coding rules, and regulatory updates

• Provide feedback and targeted education to reduce repeat errors and improve documentation quality

Data Analysis

• Analyze audit data to identify systemic issues, coding trends, and outliers

• Support revenue integrity initiatives through actionable insights and performance metrics