Medical Coding Auditor - Surgical Services

ESSENTIAL DUTIES AND RESPONSIBILITIES The responsibilities listed here represent the majority of the role but are not all-inclusive; other duties may be assigned.

• Conduct comprehensive retrospective audits of professional surgical and critical care services to evaluate coding accuracy, documentation support, and compliance.
• Review medical records, operative reports, critical care documentation, and related clinical information to validate CPT, ICD-10-CM, HCPCS Level II codes, and modifiers.
• Evaluate whether reported services are supported by provider documentation, including medical necessity, level of service, procedure complexity, and applicable coding requirements.
• Identify potential overcoding, undercoding, incorrect code selection, modifier misuse, unbundling, and other coding or billing compliance risks.
• Perform focused and ad hoc audits based on identified risk areas, payer trends, specialty-specific concerns, denials, or changes in coding and regulatory requirements.
• Audit surgical procedures and critical care services, including procedure coding, evaluation and management (E/M) services, critical care time, concurrent services, and applicable modifiers.
• Assess documentation and coding against CMS, commercial payer, AMA, NCCI, and other applicable coding and regulatory requirements.
• Analyze audit findings to identify trends, root causes, and opportunities for improvement across providers, service lines, and coding operations.
• Prepare clear, actionable audit reports documenting findings, supporting coding references, financial and compliance implications, and recommended corrective actions.
• Partner with physicians, advanced practice providers, coding teams, and operational leadership to provide education and clarify documentation and coding requirements.
• Develop and support provider education initiatives based on recurring audit findings and identified documentation or coding opportunities.
• Review coding-related denials, payer feedback, and reimbursement trends to identify potential audit targets and opportunities for process improvement.
• Maintain current knowledge of surgical, critical care, E/M, and specialty-specific coding guidelines, payer policies, annual code updates, and regulatory requirements.
• Serve as a subject matter resource for surgical and critical care coding, documentation, and compliance questions.
• Support special projects, targeted reviews, external audits, and other revenue cycle initiatives involving coding accuracy, compliance, and reimbursement integrity.
• Maintain audit productivity, quality, and reporting benchmarks established by the department.

QUALIFICATIONS

Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• Strong knowledge of surgical medical terminology, anatomy, and pathophysiology, with familiarity with critical care terminology and documentation.
• Strong understanding of CPT procedure coding, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis coding.
• Knowledge of professional fee coding for services performed in surgical practices, ambulatory surgery centers, and hospital settings.
• Ability to evaluate documentation for medical necessity and coding compliance.
• Strong understanding of National Correct Coding Initiative (NCCI) edits and bundling guidelines.
• Ability to conduct coding audits and formal quality reviews, identify trends, and recommend corrective actions.
• Advanced analytical and problem-solving skills.
• High attention to detail and accuracy.
• Proficiency with EHR systems, practice management systems, and claim scrubber tools.
• Strong written and verbal communication skills, including the ability to prepare clear audit reports, explain findings using coding references, and provide constructive coding and documentation education.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency in Microsoft Office applications.
• Ability to maintain confidentiality and exercise professional discretion.

Education / Experience:  Includes minimum education, technical training, and/or experience preferred to perform the job.

Required:

• High school diploma or equivalent.
• Minimum five (5) years of professional medical coding experience including at least two (2) years conducting coding audits or formal coding quality reviews.
• Demonstrated experience auditing professional surgical services and evaluating operative documentation, code selection, modifiers, and documentation support.
• Experience documenting audit findings, identifying trends, and recommending corrective actions.
• Experience applying CMS, commercial payer, and National Correct Coding Initiative (NCCI) coding requirements.
• Active Certified Professional Coder (CPC) certification through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist – Physician-based (CCS-P) certification through the American Health Information Management Association (AHIMA).

Preferred:

• Certified Professional Medical Auditor (CPMA) through AAPC.
• Experience auditing critical care and evaluation and management (E/M) services.
• Experience providing coding and documentation education to providers or coding teams.
• Experience with CMS Part B and commercial payer reimbursement methodologies.

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms.
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job

• Hybrid office environment or flexible for remote 
  • Corporate office: 4835 Lyndon B Johnson Fwy, Dallas, TX 75244
• If remote, must reside in a state IES operates in
  • Arizona, Colorado, Texas, Oklahoma, Indiana, Missouri, Alabama, South Carolina, & Florida

TRAVEL:

• Some travel, including overnight and local, may be required as business needs dictate.

ADA & Reasonable Accommodation Statement:
IES is committed to providing equal employment opportunities to qualified individuals with disabilities. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. If you require accommodation during the application or employment process, please contact humanresources@ies.healthcare.

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.