Surgical Coding Auditor

Position Summary

The Coding Auditor conducts internal coding audits across assigned specialties and accounts to assess coding accuracy, documentation sufficiency, and compliance with applicable coding guidelines and payer requirements. This role produces well-documented audit findings, supports corrective action follow-through, and contributes to the department's compliance monitoring and education efforts. The Coding Auditor works closely with the Senior Coding Auditor and Coding Compliance & Audit Manager to develop technical skills, deliver consistent audit quality, and grow into an increasingly independent contributor within the audit program.

Key Responsibilities

Audit Execution

• Conduct routine coding audits across assigned specialties and client accounts, reviewing clinical documentation and coded encounters for accuracy, documentation alignment, and compliance with applicable guidelines
• Apply ICD-10-CM, CPT, HCPCS, modifier rules, and payer-specific requirements to audit findings; support all determinations with clearly cited, authoritative references
• Complete assigned audit volumes within established turnaround expectations and quality standards
• Escalate complex or unclear coding scenarios to the Senior Coding Auditor for guidance and resolution

Finding Documentation & Reporting

• Document audit findings with accuracy and clarity, including discrepancy identification, root cause classification, and corrective recommendations
• Prepare individual audit reports and summary submissions in accordance with department templates and standards
• Maintain organized, complete audit records and files in accordance with department documentation requirements
• Compile audit data for submission to the Coding Compliance & Audit Manager for trend analysis and reporting

Corrective Action & Education Support

• Communicate audit findings to audited coders in a professional, constructive, and guideline-grounded manner
• Support delivery of audit-driven education, including written feedback, reference materials, and participation in team huddles or education sessions
• Assist in re-auditing previously identified findings to assess corrective action effectiveness
• Identify patterns in assigned audit findings and report observations to the Coding Compliance & Audit Manager and Senior Coding Auditor

Compliance Monitoring

• Remain current with applicable coding guidelines, payer updates, and regulatory requirements relevant to assigned specialties
• Flag potential compliance risks or emerging accuracy issues identified during audit activity to the Senior Coding Auditor or Coding Compliance & Audit Manager
• Support audit readiness activities and contribute to audit program documentation as directed

Key Performance Indicators

• Audit completion rate and turnaround time against assigned schedule
• Audit finding accuracy and documentation quality (validated through supervisor review and calibration)
• Escalation timeliness and appropriateness
• Quality of corrective feedback delivered to audited coders
• Contribution to re-audit completion and corrective action follow-through

Experience & Requirements

• High School Diploma or equivalent required; Associate's or Bachelor's degree preferred
• 0-2 years of experience in physician collections, A/R follow-up, and denial management
• Proficiency in Microsoft Office applications (Excel, Word, Outlook); experience with reporting and data analysis tools preferred
• Proven ability to multi-task, prioritize workload, and meet deadlines in a fast-paced environment
• Strong communication and interpersonal skills

Additional Qualifications

• Exceptional attention to detail and organizational skills.
• Ability to work independently while contributing to a team-oriented environment
• Demonstrated problem-solving skills with a proactive and solution-driven approach