Coding Auditor

Cypress Surgery Center, LLC; United States; On-site; USD 75,000 - 105,000; Full time

Job summary

Surgery Partners is seeking a Coding Auditor to evaluate the quality, accuracy, compliance, and consistency of coding across internal and outsourced vendors in ASC, Hospital Outpatient, and Professional Fee lines. This role reports to the Coding Vendor Manager and performs comprehensive audits and trend analyses.

You will review ICD-10-CM/PCS, CPT, HCPCS, CMS and payer policies, validate documentation, and provide coder education.

Qualifications

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

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/PCS, CPT, HCPCS, CMS, NCCI, payer policies, and standards.
• Validate documentation and medical necessity.
• Prepare audit reports, dashboards, and trend analyses.

Skills

Coding audits

Auditing

Analytical

Communication

Documentation review

Encoder systems

EHR systems

Auditing software

Excel

Microsoft Office

Education

Bachelor's degree or equivalent experience

Tools

Encoder systems

EHRs

Auditing software

Excel

Microsoft Office

Job description

Coding Auditor Position

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.

Equal Employment Opportunity & Work Force Diversity

Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws. This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc. Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.

Surgery Partners conducts pre-employment screenings including but not limited to criminal background checks and drug testing.