1099 Surgery Auditor

Pinnacle Healthcare Consulting LLC

2d

About The Position

The 1099 Surgery Auditor plays a critical role in ensuring the accuracy, compliance, and integrity of surgical billing and documentation processes. This 1099 position involves conducting detailed audits of surgical claims to verify that all procedures are properly coded and supported by medical records, thereby minimizing errors and potential fraud. The auditor will work independently to analyze complex surgical data, identify discrepancies, and provide actionable recommendations to improve billing practices. By maintaining up-to-date knowledge of healthcare regulations and coding standards, the auditor helps safeguard organizational compliance and optimize reimbursement. Ultimately, this role contributes to the financial health of healthcare providers while supporting ethical and transparent surgical billing operations.

Requirements

• Proven experience in medical auditing, specifically related to surgical procedures and billing.
• Strong knowledge of CPT, ICD-10, and HCPCS coding systems relevant to surgery.
• Familiarity with healthcare compliance regulations such as HIPAA and Medicare/Medicaid billing requirements.
• Excellent analytical skills with attention to detail and accuracy.
• Ability to work independently as a 1099 contractor with strong time management and organizational skills.

Nice To Haves

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Experience working with electronic health records (EHR) and medical billing software.
• Background in healthcare compliance or risk management.
• Prior experience auditing surgical claims for insurance companies or healthcare providers.
• Strong communication skills for effectively liaising with clinical and administrative staff.

Responsibilities

• Review and audit surgical claims and related documentation for accuracy, completeness, and compliance with applicable coding standards and regulations.
• Analyze medical records to verify that surgical procedures are properly documented and coded according to current guidelines.
• Identify discrepancies, errors, or potential fraud in surgical billing and report findings with detailed explanations and recommendations.
• Collaborate with healthcare providers, billing teams, and compliance officers to resolve audit findings and implement corrective actions.
• Maintain thorough records of audit activities and prepare comprehensive reports to support internal and external reviews.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 51-100 employees