Medical Coding and Billing Compliance Auditor

Medical Coding and Billing Compliance Auditor

Location : Remote

Department : Coding Compliance

About the Role :

The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy, documentation integrity, 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 :

Preferred :

Skills & Competencies

Performance Metrics