Coding-Auditor Specialist

The Coding Auditor is responsible for ensuring accurate, compliant professional coding with a strong emphasis on Evaluation & Management (E/M) services. This role performs pre- and post-bill audits, validates documentation support, and drives coding accuracy across providers and coding teams. The position also communicates audit findings, identifies trends, and supports ongoing education to maintain high-quality standards.

• *Duties and Responsibilities
• Perform detailed audits of physician documentation and coding with emphasis on E/M services and procedure coding (e.g., laceration repair, I&D, debridement, fracture care, critical care)
• Validate that documentation supports both E/M leveling and procedures billed, ensuring accuracy prior to claim submission
• Conduct pre- and post-bill audits to identify coding errors, compliance risks, and missed revenue opportunities
• Review coding for emergency medicine, urgent care, and wound care encounters for accuracy and guideline adherence
• Identify and report coding trends, patterns, and compliance concerns; recommend corrective actions
• Provide clear, actionable feedback and education to providers and coding staff to improve accuracy and consistency
• Ensure appropriate application of modifiers, bundling rules, and NCCI edits
• Escalate complex, high-risk, or compliance-related findings per policy
• Maintain current knowledge of CPT, HCPCS, ICD-10, and CMS/AMA guidelines, including E/M updates
• Support denial management through coding review, corrections, and appeal recommendations
• Meet productivity and quality benchmarks:
• Coding: 18–20 charts/hour
• Auditing: 22–24 charts/hour
• Accuracy: ≥95%
• Participate in special projects, second-level reviews, and ongoing process improvement efforts
• Performs related work and projects as required
• *Qualifications
• High school diploma required; Associate degree or equivalent experience preferred
• CPC, CCS, or equivalent certification (AAPC/AHIMA) strongly preferred; must maintain CEUs
• 2+ years of professional coding/auditing experience in a physician/RCM setting
• Strong expertise in E/M coding across ED, urgent care, wound care, inpatient, and observation services
• Experience coding/auditing procedures and applying appropriate modifiers
• Proficient in CPT, ICD-10, HCPCS, and documentation requirements
• Working knowledge of CMS, Medicare/Medicaid, MIPS, and payer-specific guidelines, including denial management
• Knowledge of billing rules for split/shared services and resident documentation requirements
• Understanding of physician billing, reimbursement methodologies, and compliance standards
• Ability to interpret medical records, identify deficiencies, and ensure accurate code assignment
• Experience researching and applying coding rules and regulations
• Strong analytical, critical thinking, and attention to detail
• Effective communication skills with providers and cross-functional teams
• Ability to work independently, manage priorities, and meet productivity and quality standards
• Proficiency in EMR systems, data entry, Excel, and Microsoft Office tools
• Positive, professional, respectful attitude

Pay: From $25.00 per hour

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

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