Certified Medical Auditor

UBMD Physicians' Group; Buffalo (NY); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

401(k) with matching

Health insurance

Dental insurance

Paid time off

Parental leave

Job summary

UB Associates, Inc. is seeking a Certified Medical Auditor to perform comprehensive audits of medical records, coding, billing, and compliance.

The role collaborates with coding, clinical, billing, and leadership teams to improve documentation accuracy and support audit initiatives. The candidate will review ICD-10-CM, CPT, HCPCS, and other coding for accuracy, evaluate medical necessity, and prepare detailed reports with recommendations and corrective actions.

Qualifications

• Certified Medical Auditor (CMA) certification or equivalent.
• Solid knowledge of medical coding, documentation, billing and reimbursement.

Responsibilities

• Conduct prospective, concurrent, and retrospective medical record and coding audits.
• Review medical documentation for ICD-10-CM, CPT, HCPCS accuracy.
• Evaluate medical necessity and billing practices.
• Identify coding errors, documentation deficiencies, and compliance risks.
• Prepare audit reports with findings and corrective actions.
• Maintain audit workpapers per policy.
• Monitor trends in coding/documentation issues.
• Educate staff on audit findings and improvements.
• Assist with corrective action plans and regulatory inquiries.
• Stay current with coding and payer policy changes.

Skills

CMA certification

Medical coding

ICD-10-CM

CPT/HCPCS

CMS regulations

Analytical skills

Communication skills

HIPAA compliance

Audit documentation

Excel/Word

Education

HIM/Healthcare Admin degree

Tools

Microsoft Office

Job description

Position Summary

The Certified Medical Auditor is responsible for conducting comprehensive medical record, coding, billing, and compliance audits to ensure accuracy, completeness, regulatory compliance, and adherence to organizational policies and industry standards. This position reviews clinical documentation and coded data to identify discrepancies, overpayments, underpayments, compliance risks, and opportunities for process improvement.

The Certified Medical Auditor works collaboratively with coding, clinical, billing, compliance, and leadership teams to educate staff, improve documentation and coding accuracy, and support ongoing audit and compliance initiatives.

Essential Duties And Responsibilities

• Conduct prospective, concurrent, and retrospective medical record and coding audits.
• Review medical documentation to validate the accuracy and completeness of ICD-10-CM, CPT, HCPCS, and other applicable coding.
• Evaluate medical necessity, documentation requirements, code assignment, and billing practices.
• Identify coding errors, documentation deficiencies, compliance risks, overcoding, undercoding, unbundling, incorrect modifiers, and other billing discrepancies.
• Calculate audit findings, financial impact, error rates, and potential reimbursement implications.
• Prepare detailed audit reports outlining findings, supporting documentation, recommendations, and corrective actions.
• Maintain accurate audit workpapers and documentation in accordance with organizational policies.
• Monitor trends and identify recurring coding and documentation issues.
• Provide education and feedback to coders, providers, clinical staff, and billing personnel based on audit findings.
• Assist with the development and implementation of corrective action and performance improvement plans.
• Perform focused and targeted audits based on identified compliance risks or organizational priorities.
• Assist with internal and external audit requests and regulatory inquiries.
• Stay current with changes to coding guidelines, payer policies, CMS requirements, federal and state regulations, and industry standards.
• Participate in coding and compliance education initiatives.
• Collaborate with Compliance, Revenue Cycle, HIM, Clinical Operations, and Coding leadership.
• Maintain confidentiality of patient, provider, employee, and organizational information.
• Support organizational compliance with HIPAA and applicable federal and state regulations.
• Perform additional auditing, coding, compliance, and analytical duties as assigned.

Qualifications

Required

• Certification as a Certified Medical Auditor (CMA) or equivalent recognized auditing certification.
• Strong knowledge of medical coding, documentation, billing, and reimbursement principles.
• Knowledge of ICD-10-CM, CPT, HCPCS, and applicable coding guidelines.
• Understanding of CMS regulations, Medicare/Medicaid requirements, and commercial payer policies.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to interpret medical records and clinical documentation.
• Ability to work independently while effectively collaborating with multidisciplinary teams.
• Strong attention to detail and ability to maintain accurate audit documentation.
• Proficiency with Microsoft Office applications, including Excel and Word.

Preferred

• Associate or bachelor's degree in health information management, Healthcare Administration, Nursing, Business, or a related field.
• RHIA, RHIT, CPMA, CEMA, CPC, or other relevant coding/HIM certification.
• Experience performing professional, facility, outpatient, inpatient, or risk-adjustment audits.
• Experience with healthcare compliance and regulatory requirements.
• Experience developing audit reports, presenting findings, and providing coding/documentation education.

Knowledge And Skills

• Medical coding and auditing methodologies
• Clinical documentation requirements
• Healthcare reimbursement systems
• Regulatory and compliance requirementsAudit sampling and methodology
• Root-cause analysis
• Data analysis and reporting
• Risk identification and mitigation
• Provider and coder education
• Effective communication and presentation skills
• Confidentiality and HIPAA requirements

Performance Expectations

The Certified Medical Auditor Is Expected To

• Complete assigned audits accurately and within established deadlines.
• Maintain a high level of accuracy and consistency in audit findings.
• Clearly communicate audit results and recommendations.
• Identify opportunities to reduce coding and documentation errors.
• Support continuous improvement in coding, documentation, compliance, and reimbursement processes.
• Maintain current knowledge of regulatory and coding changes.
• Demonstrate professionalism, integrity, objectivity, and confidentiality in all auditing activities.

Why You'll Love Working Here

• Supportive team environment where your work directly impacts patient care and organizational success
• Comprehensive benefits including 401(k) with matching, health, dental, vision, and life insurance, plus paid time off
• Meaningful work contributing to process improvements and operational efficiency

Benefits

• Flexible spending account (FSA)
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Retirement plan

UB Associates, Inc. is an Equal Employment Opportunity (EEO) employer.