Facility Outpatient Auditor - ED, SDS, OBS, I&I

Jobgether; United States; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Remote work flexibility

Professional development

Career growth

Collaborative environment

Meaningful impact

Job summary

Jobgether is seeking a Facility Outpatient Auditor to review and improve coding accuracy across ED, SDS, OBS, and I&I settings in a fully remote role within the United States.

You will conduct detailed medical record audits, apply official guidelines, and provide guidance to coding staff, driving revenue integrity while protecting patient data and regulatory compliance. AAPC/AHIMA credentials are required.

Qualifications

• At least two years of coding and/or auditing experience in inpatient and outpatient hospital or facility settings.
• Active coding credential from AAPC or AHIMA is required; CPC/COC/CCS preferred; RHIT/RHIA may be considered.
• Experience with facility inpatient/outpatient auditing and coding in ED, SDS, OBS, and I&I settings.
• Familiarity with hospital outpatient billing processes, APC assignment, reimbursement methods, and documentation linkage.
• Ability to interpret official coding guidelines, payer requirements, medical necessity criteria, and privacy/compliance rules.

Responsibilities

• Conduct outpatient coding audits: perform retrospective reviews across ED, SDS, OBS, and I&I services to identify errors and compliance risks.
• Validate coding accuracy and reimbursement: review diagnosis codes, procedures, and billing for compliance with standards and policies.
• Apply official coding guidelines: interpret guidance from AHA, CMS, AMA, CPT Assistant, and other sources.
• Analyze audit findings: investigate discrepancies, identify root causes, and propose corrective actions.
• Provide training and guidance: educate staff on documentation standards, guidelines, and regulatory changes.
• Identify documentation improvement opportunities: determine when physician queries are needed to ensure accurate codes.
• Monitor coding quality and productivity: track performance, report results, and help maintain target accuracy.
• Maintain QA standards: keep review percentages near internal targets and resolve issues timely.
• Develop reports and deliverables: document findings and status updates for management.

Skills

Outpatient auditing

Medical coding

Regulatory knowledge

Quality assurance

EMR proficiency

Job description

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Facility Outpatient Auditor – ED, SDS, OBS, I&I based in the United States.

In this role, you will help ensure the accuracy, quality, and compliance of hospital outpatient coding and billing across emergency department (ED), same-day surgery (SDS), observation services (OBS), and infusion and injection (I&I) settings. You will conduct detailed medical record audits, identify coding discrepancies, and assess documentation against established clinical coding and reimbursement guidelines. By analyzing audit findings and identifying root causes, you will help improve coding accuracy, reduce denials, and support appropriate reimbursement. You will collaborate with coding professionals and internal stakeholders to provide technical guidance, deliver training, and strengthen quality assurance practices. Your expertise will contribute to maintaining regulatory compliance, protecting patient information, and improving revenue cycle performance. This fully remote opportunity is suited to a detail-oriented coding professional who enjoys analytical work, continuous learning, and helping teams achieve consistently high standards.

Accountabilities

• Conduct outpatient coding audits: Perform complex retrospective reviews of medical records to identify coding and billing errors, inconsistencies, documentation gaps, and compliance risks across ED, SDS, OBS, and I&I services.
• Validate coding accuracy and reimbursement: Conduct second-level reviews of diagnosis codes, procedure codes, and billing practices to ensure compliance with applicable coding standards, regulatory requirements, and reimbursement policies.
• Apply official coding guidelines: Interpret and apply guidance from the American Hospital Association (AHA), Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), Coding Clinic, CPT Assistant, and other relevant authoritative sources.
• Analyze audit findings: Investigate coding discrepancies, identify root causes, recognize recurring quality issues, and recommend corrective actions to prevent errors from recurring.
• Support compliance and denial resolution: Research and respond to inquiries concerning coding compliance, inappropriate coding, claim denials, billable services, medical necessity, and third-party payer requirements.
• Provide technical guidance and training: Educate coding staff on documentation standards, coding guidelines, regulatory changes, reimbursement methodologies, and compliance requirements.
• Identify documentation improvement opportunities: Recognize when physician queries may be necessary based on clinical information, documentation gaps, and accurate code assignment requirements.
• Monitor coding quality and productivity: Track coder performance, review ongoing quality results, identify areas requiring improvement, and help maintain a minimum overall coder accuracy rate of 95%.
• Maintain quality assurance standards: Keep quality review percentages as close as possible to the internal target of 10%, while ensuring appropriate monitoring and timely resolution of coding issues.
• Develop reports and deliverables: Prepare monthly reports, audit findings, coder feedback, status updates, and other required documentation for management and operational stakeholders.
• Improve coding workflows: Contribute to the design and enhancement of systems, processes, and tools that improve coding accuracy, productivity, and operational efficiency.
• Maintain professional standards: Keep coding credentials current and remain informed about changes in coding practices, reimbursement methodologies, regulatory requirements, and compliance expectations.
• Protect confidential information: Safeguard patient health information and client data, following applicable privacy and security regulations, ethical coding standards, and internal compliance policies.
• Collaborate across teams: Communicate respectfully with colleagues, participate in training sessions and corporate meetings, share knowledge, and coordinate work schedules and activities with management.
• Deliver reliable results: Complete assignments accurately and on time, maintain clear communication regarding work progress, and proactively address issues that could affect coding quality or service delivery.

Requirements

• Professional experience: At least two years, preferably three or more, of coding and/or auditing experience in inpatient and outpatient hospital or facility settings.
• Coding certification: An active, recognized coding credential from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) is required. Preferred credentials include CPC, COC, or CCS; RHIT and RHIA credentials may also be considered.
• Outpatient facility expertise: Demonstrated experience with facility inpatient/outpatient auditing and coding, particularly in emergency department, same-day surgery, observation, and infusion and injection settings.
• Hospital billing knowledge: Familiarity with hospital outpatient billing processes, Ambulatory Payment Classification (APC) assignment, reimbursement methodologies, and the relationship between clinical documentation and code assignment.
• Regulatory and compliance knowledge: Ability to interpret official coding guidelines, payer requirements, medical necessity criteria, documentation standards, and applicable privacy and compliance regulations.
• Quality assurance experience: Strong ability to review coding work, identify errors, evaluate root causes, monitor quality metrics, and recommend corrective actions that improve accuracy and consistency.
• Electronic medical records proficiency: Experience working with electronic medical record (EMR) systems is strongly preferred, including the ability to navigate multiple systems and review handwritten medical records.
• Technical proficiency: Working knowledge of Microsoft Office applications, particularly Word and Excel, with the ability to prepare reports, analyze findings, and document audit results.
• Analytical skills: Excellent attention to detail, critical thinking, and problem-solving abilities, with the capacity to evaluate complex medical records and identify discrepancies accurately.
• Communication skills: Strong written and verbal communication skills, including the ability to explain coding decisions, provide constructive feedback, and communicate technical information clearly.
• Training and coaching abilities: Capacity to support coding staff through technical guidance, knowledge sharing, and feedback that promotes continuous improvement.
• Organization and time management: Ability to prioritize multiple assignments, meet deadlines, maintain accurate records, and consistently deliver high-quality work.
• Independent work and teamwork: Ability to work with minimal supervision while collaborating effectively with colleagues and supporting multiple clients and projects.
• Customer service orientation: At least one year of customer service support experience, with a commitment to responsiveness, professionalism, and client satisfaction.
• Adaptability and initiative: Demonstrated resourcefulness, initiative, and flexibility when navigating different client requirements, medical record systems, and changing priorities.
• Remote work readiness: Ability to work effectively in a remote environment, maintain predictable attendance, communicate proactively, and remain productive while managing competing deadlines.

Benefits

• Remote work flexibility: Full-time remote position for candidates residing in the United States.
• Professional development: Opportunities to maintain and expand coding expertise through ongoing education, training, and exposure to evolving reimbursement and compliance requirements.
• Career growth: Opportunities to strengthen auditing, quality assurance, and healthcare revenue cycle expertise.
• Collaborative environment: Work with coding professionals and operational teams committed to accuracy, compliance, and continuous improvement.
• Meaningful impact: Help improve hospital outpatient coding quality, reduce billing errors, support appropriate reimbursement, and strengthen healthcare financial operations.
• Continuous learning: Participate in professional training, team meetings, and knowledge-sharing initiatives that support technical development.

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We appreciate your interest and wish you the best!