Lead - Healthcare - Coding Quality Auditor
Core
Review medical records and coding practices to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in compliance with federal, state, payer, and organizational guidelines.
Role type
Senior IC medical coding quality auditor
Builds
Revenue cycle integrity and compliance for healthcare payers and organizations
Domain
Healthcare / Medical Billing & Coding
Deliverable
dashboards & analysis
Required skills
ICD-10-CM/PCS, CPT, HCPCS Level II coding, CMS regulations, NCCI guidelines, EHR systems, encoder software, audit report generation, documentation gap identification
Preferred skills
CPC, CPMA, CCS, CIC, RHIT, RHIA certifications, retrospective/concurrent/prospective audit methodologies, policy development
Technologies
EHR systems, encoder software, Microsoft Office Suite
Responsibilities
Perform retrospective, concurrent, and prospective coding audits; Review medical documentation to validate diagnosis and procedure codes; Identify coding errors and documentation gaps; Prepare detailed audit reports with findings and recommendations; Provide education to coders and providers on coding updates; Monitor coding quality metrics and develop improvement action plans
Seniority
Mid-Senior, hands-on IC