Auditor Coder Specialist
About The Position
The Auditor Coder Specialist conducts internal audits and billing compliance reviews to ensure adherence to quality standards, regulatory requirements, and coding guidelines. The role reviews provider E/M profiles, practice patterns, and previous audit findings to identify compliance risks, missed billing opportunities, and areas for improvement. It documents audit results, tracks risks and trends, and communicates findings and recommendations to stakeholders. The specialist identifies educational opportunities and helps develop training materials and action plans to improve provider documentation, coding accuracy, and billing compliance. The role also responds to coding questions through the Coding Helpline, reviews and corrects or appeals denied claims as assigned, recommends Epic edits and process improvements, and maintains project work lists and auditing software according to established procedures.
Requirements
- Two years of related work experience involving ICD-10-CM and CPT coding in an acute or ambulatory care setting.
- One of the following certifications upon hire: Certified Coding Specialist, Certified Coding Specialist - Physician Based, or Certified Professional Coder.
Nice To Haves
- Work experience in provider coding/documentation auditing and/or provider training.
Responsibilities
- Perform internal audits and billing compliance reviews to ensure adherence to established quality standards, regulatory requirements, and coding guidelines.
- Review provider E/M profiles, practice patterns, and previous audit findings to identify compliance risks, missed billing opportunities, and areas for improvement.
- Document audit results, track identified risks and trends, and communicate findings and recommendations to appropriate stakeholders.
- Identify educational opportunities and assist with developing training materials and action plans to improve provider documentation, coding accuracy, and billing compliance.
- Respond to coding questions through the Coding Helpline, providing guidance to providers, managers, and billing teams on CPT, ICD-10-CM, reimbursement, regulatory requirements, and documentation standards.
- Review and correct or appeal denied claims as assigned.
- Recommend Epic edits and process improvements to support coding accuracy and compliance.
- Maintain project work lists and auditing software in accordance with established procedures.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
