Coding Auditor

General Summary

The Coding Auditor is responsible for evaluating and improving the quality, accuracy, compliance, and consistency of coding performed by internal and outsourced coding vendors across multiple healthcare service lines, including Ambulatory Surgery Centers (ASC), Professional Fee, Hospital Outpatient, and future coding programs.

Reporting directly to the Coding Vendor Manager, this position performs comprehensive coding audits, identifies trends and educational opportunities, monitors all internal and vendor compliance with organizational coding standards, payer requirements, and regulatory guidelines, and assists with performance improvement initiatives.

Essential Responsibilities

• Perform routine and targeted audits of internal and outsourced coding vendors.
• Conduct pre-bill, post-bill, focused, and retrospective audits.
• Evaluate coding accuracy, modifier usage, sequencing, documentation support, and compliance.
• Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, CMS, NCCI, payer policies, and organizational standards.
• Validate documentation and medical necessity.
• Monitor coding quality and trends.
• Assist with scorecards and corrective action plans.
• Support internal/external audits and regulatory compliance.
• Provide coder education and feedback.
• Partner with Revenue Integrity, HIM, Compliance, CDI, and Operations.
• Prepare audit reports, dashboards, and trend analyses.
• Recommend process improvements and maintain coding policies.

Supervisory Responsibilities

• No direct supervisory responsibility. Serves as coding subject matter expert and provides audit feedback and education under the direction of the Coding Vendor Manager.

Knowledge, Skills & Abilities

• Advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS, CMS, NCCI, ASC, Hospital Outpatient, and Professional Fee coding.
• Strong analytical, communication, auditing, and documentation review skills.
• Experience with encoder systems, EHRs, auditing software, Excel, and Microsoft Office.

Education & Experience

• Bachelor's degree preferred or equivalent experience.
• Minimum 5 years coding experience.
• Minimum 3 years coding audit experience.
• Experience auditing ASC, Hospital Outpatient, and Professional Fee coding.
• Vendor auditing experience preferred.

Preferred Certifications

• CCS, CPC, CCS-P, RHIA, and/or RHIT
• CPMA a plus

Key Performance Indicators

• Coding accuracy
• Audit completion timeliness
• Quality scores
• Reduction in repeat errors
• Denial reduction
• Compliance
• Educational effectiveness

Work Environment

• Primarily remote with occasional travel supporting 58+ facility and vendor meetings, audits, and organizational initiatives.