Professional Fee Coding Auditor
Core
Independently audit inpatient and outpatient professional-fee coding for accuracy, documentation support, compliance, and reimbursement impact across a large regional healthcare network.
Role type
Senior IC Professional Fee Coding Auditor
Builds
Audit reports, compliance assessments, and facility-specific coding education
Domain
Healthcare / Medical Billing & Coding
Required skills
ICD-10-CM, CPT, HCPCS Level II, evaluation and management coding, modifier application, bundling rules, documentation review, financial impact analysis, risk assessment, corrective action planning, audit calibration, facility education delivery
Preferred skills
None stated
Technologies
Electronic health records, approved audit tools
Responsibilities
Independently audit professional-fee coding for accuracy and compliance; Evaluate ICD-10-CM, CPT, HCPCS Level II, E/M, modifiers, and bundling; Verify provider information, scope of practice, and billability; Identify noncompliant codes and modifiers; Document findings with financial impact and risk assessment; Maintain 95% audit accuracy and participate in calibration; Develop and deliver facility-specific coding education; Prepare consolidated reports on coding accuracy and process improvements.
Seniority
Senior, hands-on IC
