Lead Medical Coding Quality Auditor

Sutherland; Clifton (NJ); On-site; USD 85,000 - 120,000; Full time

Job summary

Sutherland is seeking a Lead - Healthcare - Coding Quality Auditor to ensure coding accuracy and compliance across inpatient, outpatient, and physician services. You will oversee retrospective, concurrent, and prospective audits and mentor coders to uphold ICD-10-CM/PCS, CPT, and HCPCS standards.

This role requires 3–5 years of coding experience and 2+ years in audit/quality reviews, plus relevant certifications.

Qualifications

• 3–5 years of medical coding experience in a healthcare setting.
• 2 years of coding audit or quality review experience preferred.
• Current coding certification such as CPC, CPMA, or CCS; RHIA preferred.

Responsibilities

• Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and/or specialty services.
• Review medical documentation to validate accuracy and completeness of assigned diagnosis and procedure codes.
• Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines.
• Identify coding errors, documentation gaps, and reimbursement opportunities.
• Prepare detailed audit reports outlining findings, trends, recommendations, and corrective actions.
• Provide one-on-one and group education to coders, providers, and clinical staff regarding coding updates, documentation improvement, and compliance requirements.
• Monitor coding quality metrics and develop action plans to improve coding accuracy and consistency.
• Stay current on coding regulations, Official Coding Guidelines, CMS regulations, payer policies, and industry best practices.
• Assist with internal and external audits, payer reviews, and regulatory investigations.

Skills

Analytical thinking

Attention to detail

Communication skills

Independent work

Team collaboration

Education

CPC

CPMA

CCS

RHIA preferred

Tools

Encoder software

EHR systems

Coding/audit software

Job description

Sutherland is seeking a Lead - Healthcare - Coding Quality Auditor to ensure coding accuracy and compliance across inpatient, outpatient, and physician services. You will oversee retrospective, concurrent, and prospective audits and mentor coders to uphold ICD-10-CM/PCS, CPT, and HCPCS standards.

This role requires 3–5 years of coding experience and 2+ years in audit/quality reviews, plus relevant certifications.