RCS Medical Coding Auditor (CPC, CPMA)

Veradigm®; United States; On-site; USD 57,728 - 80,243; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Job summary

Veradigm® is seeking a RCS Medical Coding Auditor to audit professional fee coding, ensuring compliance and accuracy with AMA CPT and CMS guidelines. Responsibilities include performing daily quality assurance checks, conducting medical chart audits, and providing coding education. The ideal candidate has 2+ years of experience, holds a CPC certification, and has strong analytical skills. Compensation ranges from $57,728 to $80,243 based on experience and market conditions, along with a comprehensive benefits package.

Qualifications

• 2+ years of ProFee auditing experience.
• Knowledge of modifier rules and NCCI edits.
• Strong analytical and critical-thinking skills.

Responsibilities

• Perform daily QA to ensure accuracy of completed coding.
• Validate ICD-10-CM, CPT®, HCPCS assignments against documentation.
• Conduct medical chart audits across multiple specialties.

Skills

Attention to detail

Analytical skills

Communication skills

E/M documentation

Knowledge of CPT, ICD-10-CM, HCPCS

Education

CPC Certification

CPMA Certification (in process)

Tools

EHRs

Microsoft Office Suite

Job description

Overview

RCS Medical Coding Auditor is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback. The ideal candidate brings strong hands-on experience with professional fee coding, deep knowledge of E/M, surgical, and modifier use, and the ability to translate audit findings into actionable insights.

Responsibilities

• Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback
• Validate ICD-10-CM, CPT®, HCPCS, and modifier assignment against clinical documentation to ensure accuracy and compliance with AMA CPT, ICD-10, CMS, NCCI, and payer-specific guidelines
• Conduct medical chart audits of professional services across multiple specialties
• Identify coding discrepancies, compliance risks, trends, root causes, and documentation gaps
• Support coding education through feedback, targeted training, and reference materials
• Prepare clear, defensible audit documentation including rationale and references
• Provide actionable recommendations to address audit findings and reduce future risk
• Track audit outcomes and trends to support leadership reporting and risk mitigation strategies
• Support denial prevention, resolution and appeal strategies
• Collaborate across teams to assist with coding support
• Maintain confidentiality and comply with HIPAA and organizational policies

Required Qualifications

• CPC (Required) and CPMA (Required/In Process)
• 2+ years of ProFee auditing experience
• Knowledge of:
• E/M documentation guidelines
• Modifier rules and NCCI edits
• CPT, ICD-10-CM, HCPCS Level II
• High attention to detail with strong analytical and critical-thinking skills
• Excellent written and verbal communication skills for audit reporting and education
• Proficiency with EHRs, coding and auditing tools
• Proficiency with Microsoft Office Suite

Preferred Qualifications

• Multi-specialty coding and auditing experience with preferred background in E/M Coding, Orthopedics, Pain Management, Urology
• Background in coding quality programs or compliance teams
• Advanced reporting skills for audit tracking and trend analysis
• Prior consulting or client-facing audit experience

Compensation

$57,728-$80,243

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ contributions and support their professional growth.

About Veradigm

Veradigm believes in empowering associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings. Veradigm is an equal employment opportunity employer and supports a diverse, inclusive workforce. Verification of employment eligibility may be required where applicable. Visa sponsorship is not offered for this position.