Medical coding auditor

Randstad; United States; Remote; USD 55,000 - 96,000; Full time

Benefits offered by this job

Medical benefits

Prescription coverage

Dental insurance

Vision insurance

AD&D

Life insurance

Short-term disability

401K plan

Job summary

Randstad is seeking Medical Coding Auditors to work remotely. The role oversees risk-based audits of professional coding and billing workflows, validating coding accuracy, medical necessity, and modifier usage.

You will leverage Epic workflows and MD audit tools to spot risks, analyze trends, and report clearly to physicians and APCs. The position requires 5+ years in coding/audit, deep CPT/HCPCS/ICD-10-CM knowledge, and familiarity with CMS/payer policies.

Qualifications

• 5+ years of professional coding, billing, or healthcare audit experience, including risk-based auditing.
• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, bundling, and current E/M guidelines.
• Experience with Medicare, Medi-Cal, commercial payer policies, CMS manuals, NCDs/LCDs, and payer-specific billing requirements.
• Experience conducting prospective and retrospective audits validating coding, documentation, medical necessity, and modifier usage.
• Proficiency in Epic charge review, claim/edit workflows, workqueues, coding documentation, and billing documentation.
• Experience identifying overcoding, undercoding, unbundling, unsupported services, documentation deficiencies, and compliance risks.
• Ability to analyze audit results, error rates, financial impact, coding trends, and recurring root causes.
• Ability to develop defensible audit samples, maintain consistent audit decisions, and support inter-rater reliability.
• Ability to translate complex coding findings into clear, defensible reporting and education for physicians and APCs.
• Experience researching authoritative coding guidance including CPT Assistant, Coding Clinic, CMS guidance, and payer policies.

Responsibilities

• Validate code assignment, documentation, medical necessity, modifier usage, E/M coding, bundling, and payer-specific requirements.
• Use Epic workflows and MD audit reporting tools to identify coding and compliance risks, analyze error trends and financial impact, and determine root causes.
• Develop audit samples, maintain defensible audit documentation, and clearly communicate findings to physicians and APCs.
• Recommend education, workflow improvements, Epic or edit changes, and monitoring strategies while managing multiple audits, deadlines, and CMS/payer updates.

Skills

Risk-based auditing

Coding knowledge

Billing audits

Data analysis

Report writing

Communication

Tools

Epic

MD audit software

Job description

Top Healthcare company is hiring Medical Coding Auditors to work Remotely!

The Coding Auditor conducts risk-based prospective and retrospective audits across professional coding and billing workflows.

Responsibilities

• validating code assignment, documentation, medical necessity, modifier usage, E/M coding, bundling, and payer-specific requirements.
• The auditor will use Epic workflows and MD audit reporting tools to identify coding and compliance risks, analyze error trends and financial impact, and determine root causes.
• This role develops appropriate audit samples, maintains defensible and consistent audit documentation, and communicates findings clearly to physicians and APCs.
• The auditor will also recommend education, workflow improvements, Epic or edit changes, and monitoring strategies while managing multiple concurrent audits, reporting deadlines, and evolving CMS, CPT, ICD-10-CM, and payer requirements.

Requirements

• 5+ years of professional coding, billing, or healthcare audit experience, including risk-based auditing
• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, bundling, and current E/M guidelines
• Experience with Medicare, Medi-Cal, commercial payer policies, CMS manuals, NCDs/LCDs, and payer-specific billing requirements
• Experience conducting prospective and retrospective audits validating coding, documentation, medical necessity, and modifier usage
• Proficiency in Epic charge review, claim/edit workflows, workqueues, coding documentation, and billing documentation
• Experience identifying overcoding, undercoding, unbundling, unsupported services, documentation deficiencies, and compliance risks
• Ability to analyze audit results, error rates, financial impact, coding trends, and recurring root causes
• Ability to develop defensible audit samples, maintain consistent audit decisions, and support inter-rater reliability
• Ability to translate complex coding findings into clear, defensible reporting and education for physicians and APCs
• Experience researching authoritative coding guidance including CPT Assistant, Coding Clinic, CMS guidance, and payer policies

Preferred Requirements

• Experience with MD audit software, including audit management, findings tracking, trending, and reporting
• Experience quantifying underpayments, overpayments, missed revenue, and compliance exposure
• Ability to distinguish individual coding errors from systemic workflow, Epic build, documentation, or training issues
• Experience recommending provider education, workflow changes, Epic changes, edit development, or ongoing monitoring
• Experience using utilization, reimbursement, coding patterns, and historical findings to prioritize high-risk providers or services
• Ability to quickly incorporate annual CPT/ICD updates, CMS rule changes, and payer-policy updates

CONTRACT ROLE FOR 6 MONTHS

Shift: Day 5x8-Hour

Equal Opportunity Employer

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [e-mail].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

Benefits

• medical
• prescription
• dental
• vision
• AD&D
• life insurance offerings
• short-term disability
• 401K plan

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.