Remote Medical Coding Auditor: Risk & Compliance

Randstad NV; 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

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.