Provider Coding Auditor: Inpatient & Outpatient

Sinai Chicago; Chicago (IL); On-site; USD 90,000 - 120,000; Full time

Job summary

Sinai Chicago is seeking an experienced provider-side billing auditor to perform comprehensive coding audits for inpatient and outpatient physician services. You will review E&M levels, validate medical necessity per payer guidelines, and ensure accurate code assignment using ICD-10-CM/PCS, CPT, and HCPCS.

Collaboration with CDI, Revenue Cycle, Compliance, and Billing teams is essential. The role emphasizes audit documentation, education to improve documentation practices, and participation

Responsibilities

• Perform comprehensive provider-side (professional billing) coding audits for inpatient and outpatient physician services
• Review and validate E&M levels of service in accordance with current coding guidelines
• Validate medical necessity based on Medicare, Medicaid, and commercial payer requirements
• Audit and validate ICD-10-CM, ICD-10-PCS (as applicable), CPT, and HCPCS coding for professional services
• Evaluate physician documentation to ensure accurate code assignment and appropriate level of care
• Conduct charge validation, charge entry review, and charge correction recommendations
• Identify documentation gaps, coding discrepancies, and compliance risks
• Provide real-time and retrospective provider education to improve documentation and coding practices
• Collaborate with CDI, Revenue Cycle, Compliance, and Billing teams to ensure alignment
• Review and interpret Explanation of Benefits (EOBs) and assist with coding-related denial resolution
• Support denial prevention initiatives and revenue integrity strategies
• Ensure compliance with HIPAA regulations and organizational policies
• Utilize Epic EMR and related systems for audit workflows and reporting
• Participate in internal audits, quality reviews, and performance improvement initiatives
• Maintain detailed audit documentation, reporting, and productivity metrics

Job description

Sinai Chicago is seeking an experienced provider-side billing auditor to perform comprehensive coding audits for inpatient and outpatient physician services. You will review E&M levels, validate medical necessity per payer guidelines, and ensure accurate code assignment using ICD-10-CM/PCS, CPT, and HCPCS.

Collaboration with CDI, Revenue Cycle, Compliance, and Billing teams is essential. The role emphasizes audit documentation, education to improve documentation practices, and participation