Senior Healthcare Coding Quality Auditor

Sutherland; Clifton (NJ); On-site; USD 90,000 - 120,000; Full time

Job summary

Sutherland seeks a Lead - Healthcare Coding Quality Auditor to ensure coding accuracy and compliance across inpatient, outpatient, and physician services. The role conducts audits, reviews documentation, and educates staff on ICD-10-CM/PCS, CPT, HCPCS, and CMS regulations, while supporting revenue cycle integrity and risk mitigation.

Strong analytical skills and attention to detail are essential. The position also requires PHI confidentiality and cross-functional collaboration to drive quality

Qualifications

• Minimum 3-5 years of medical coding experience in a healthcare setting.
• Minimum of 2 years of coding audit or quality review experience preferred.
• Current coding certification such as CPC, CPMA, CCS, RHIA preferred.

Responsibilities

• Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and/or specialty services.
• Review medical documentation to validate the accuracy and completeness of assigned diagnosis and procedure codes.
• Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines.
• Identify coding errors, documentation gaps, and reimbursement opportunities.
• Prepare detailed audit reports outlining findings, trends, recommendations, and corrective actions.
• Provide one-on-one and group education to coders, providers, and clinical staff regarding coding updates, documentation improvement, and compliance requirements.
• Monitor coding quality metrics and develop action plans to improve coding accuracy and consistency.
• Stay current on coding regulations, Official Coding Guidelines, CMS regulations, payer policies, and industry best practices.
• Assist with internal and external audits, payer reviews, and regulatory investigations.
• Maintain confidentiality of PHI in accordance with HIPAA regulations.
• Participate in policy development, process improvement initiatives, and coding education programs.
• Track audit results and identify recurring trends to support continuous quality improvement.

Skills

Medical coding

Coding audits

ICD-10-CM/PCS

CPT/HCPCS coding

CMS regulations

EHR software

Quality assurance

Education delivery

Tools

Encoder software

EHR software

Job description

Sutherland seeks a Lead - Healthcare Coding Quality Auditor to ensure coding accuracy and compliance across inpatient, outpatient, and physician services. The role conducts audits, reviews documentation, and educates staff on ICD-10-CM/PCS, CPT, HCPCS, and CMS regulations, while supporting revenue cycle integrity and risk mitigation.

Strong analytical skills and attention to detail are essential. The position also requires PHI confidentiality and cross-functional collaboration to drive quality