Medical Coding Auditor
Core
Conduct prospective and retrospective compliance reviews of medical documentation to ensure billing accuracy, maximize charge capture, and adhere to Federal, State, and payer regulations.
Role type
Senior Medical Coding Auditor
Builds
Accurate billing submissions and compliant medical records for healthcare providers and facilities
Domain
Healthcare administration and medical billing compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ICD-10-CM diagnosis coding, CPT/HCPCS coding, auditing principles, regulatory compliance analysis, risk assessment, policy development, HIPAA compliance, training delivery, EMR auditing
Preferred skills
Medicare audit experience, multi-specialty coding knowledge, advanced technical knowledge in surgical or medical specialties
Technologies
Electronic Medical Record (EMR) systems
Responsibilities
Conduct coding audits for technical and professional components of services, track coding issues by provider and present education, perform routine and targeted EMR auditing for PHI integrity, develop written policies and audit tools, investigate HIPAA and compliance issues, implement compliance audits and special projects, analyze medical record documentation to assess code accuracy, conduct follow-up audits to appraise corrective actions
Seniority
Senior, hands-on IC