Medical Coding Auditor

Jobtailor; Virginia (MN); On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor in the United States is seeking a Health Care Compliance Auditor specializing in medical coding and documentation compliance. You will review records, ensure CPT/E&M coding accuracy, and report findings to the Compliance Officer and executive leadership.

Qualifications include CPC/CCS-P/COC, 2+ years in health care, HIPAA knowledge, and Epic EMR familiarity. The role emphasizes auditing, policy development, training, and collaboration to strengthen internal controls.

Qualifications

• 2+ years of experience in health care.
• Medical coding certification required (CPC, CCS-P, COC), preferred.
• Advanced knowledge of medical terminology, techniques and CPT coding.
• Excellent understanding of HIPAA regulations.
• Knowledge of Epic EMR preferred.

Responsibilities

• Follows established protocols, selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for compliance with regulations.
• Communicates audit progress and findings to Compliance Officer and executive leadership.
• Investigates, evaluates, and identifies opportunities for improvement and internal controls.
• Develops and maintains professional skills through conferences, seminars, and publications.
• Conducts billing and coding training related to billing, coding, and documentation compliance.
• Assists with development and review of policy procedures to ensure compliance with laws and policies.
• Supports education materials related to documentation and coding and regulatory compliance.
• Reviews documentation and coding and compiles information for QA/QI committees and boards.
• Participates in monitoring reviews and audits by regulatory agencies.
• Analyzes provider documentation to ensure correct E&M levels and CPT coding.
• Fields coding questions from staff.

Skills

Medical coding

Billing compliance

Documentation compliance

CPT coding

E&M levels

Internal controls

Policy development

Auditing

Training development

Data analysis

Education

CPC

CCS-P

COC

Tools

Epic EMR

Job description

Responsibilities

• Follows established protocols, selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for compliance with all regulations for federal and state agencies, third-party payers, and organization policy.
• Communicates audit progress and findings by preparing reports and providing information to the Compliance Officer, Chief Medical Officer, and Chief Quality Officer as applicable.
• Investigates, evaluates, and identifies opportunities for improvement, recognizes their relative significance in the overall system, and provides guidance to departments regarding internal controls.
• Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars, and other educational programs, participation in professional organizations, and review of current literature.
• Conducts billing and coding training, including provider training, as they relate to billing, coding, and documentation compliance.
• Assists with the development and review of policy and procedures and provides necessary staff support and resources to develop and maintain policies to ensure compliance with designated federal and state laws, regulations, and policies.
• Assists the Compliance Officer in developing and implementing education and training materials related to documentation and coding, as well as regulatory compliance.
• Supports the Compliance Officer in the review of, and response to, documentation and coding reviews and quality and program audits, compiling information for submission to the QA/QI Committee and Board of Directors.
• Participates in monitoring reviews and audits conducted by various regulatory agencies.
• Analyzes provider documentation to assure the appropriate Evaluation and Management (E&M) levels are assigned using the correct CPT code.
• Fields coding questions from clinical and ancillary staff.
• Other duties as assigned.

Requirements

• 2+ years of experience in health care
• Medical coding certification required (CPC, CCS-P, COC), preferred minimum 1-year experience actively using certification.
• Advanced knowledge of medical terminology, techniques and surgical procedures; anatomy and physiology, and major disease processes.
• Excellent understanding of HIPAA regulations.
• Knowledge of Epic EMR preferred.

Hard Skills

• medical coding
• billing compliance
• documentation compliance
• CPT coding
• Evaluation and Management (E&M) levels
• internal controls
• policy development
• auditing
• training development
• data analysis

Soft Skills

• communication
• investigative skills
• organizational skills
• guidance
• collaboration
• problem-solving
• attention to detail
• reporting
• adaptability
• professional development

Certifications & Qualifications

• CPC
• CCS-P
• COC