Certified Medical Auditor

UB Associates; Buffalo (NY); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Flexible spending account (FSA)

Health insurance

Life insurance

Paid time off

Parental leave

Retirement plan

Job summary

Hirebridge is seeking a Certified Medical Auditor to lead comprehensive medical record, coding, billing, and compliance audits in our Buffalo, NY team. You will review ICD-10-CM, CPT, HCPCS data and collaborate with coding, clinical, billing, and leadership staff.

This role requires CMA certification, meticulous audit workpapers, and the ability to educate staff on documentation improvements while staying current with CMS and payer requirements.

Qualifications

• Certification as CMA or equivalent auditing certification.
• Strong knowledge of medical coding, documentation, billing, and reimbursement principles.
• Knowledge of ICD-10-CM, CPT, HCPCS and coding guidelines.

Responsibilities

• Conduct prospective, concurrent, and retrospective medical record and coding audits.
• Review medical documentation to validate accuracy of ICD-10-CM, CPT, HCPCS data.
• Evaluate medical necessity, documentation requirements, code assignment, and billing practices.
• Identify coding errors, documentation deficiencies, compliance risks, and billing discrepancies.
• Prepare audit findings and detailed reports with recommendations and corrective actions.

Skills

Certified Medical Auditor

Medical coding knowledge

ICD-10-CM CPT HCPCS

CMS Medicare/Medicaid rules

Analytical skills

Communication skills

Team collaboration

Attention to detail

Microsoft Excel

Microsoft Word

Education

Bachelor’s or Associate degree in HIM/Health Info or related field

RHIA/RHIT/CPMA/CEMA/CPC or similar HIM certification

Tools

Excel

Word

Job description

Certified Medical Auditor

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 requirements
• Audit 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.