Coding Auditor (100% Work from Home)
About The Position
The Coding Audit and Support Specialist performs independent coding audits to validate the accuracy, completeness, compliance, and defensibility of coding outcomes. The role supports Revenue Integrity’s assurance and risk oversight function by reviewing coded encounters, documenting findings with evidence and context, and surfacing defects or risk patterns for accountable leaders to address. This is an individual contributor role within Revenue Integrity. It executes assigned audits, maintains objective documentation, and escalates material risks, repeat defects, or unclear scenarios through defined channels. The role does not perform coding work, correct encounters, deliver provider education, determine compliance policy, own corrective action, or manage customer outcomes.
Requirements
- Working knowledge of medical coding standards, including ICD-10-CM, CPT, and HCPCS.
- Understanding of coding accuracy, documentation requirements, audit standards, and compliance concepts.
- Ability to review coded encounters objectively and identify discrepancies, documentation gaps, risk indicators, and repeat defect patterns.
- Strong analytical judgment to distinguish isolated errors from material issues that require escalation.
- Clear written communication skills for documenting findings, supporting evidence, and audit rationale.
- Ability to manage assigned audit work independently while following defined methodology, scope, and escalation standards.
- Professional communication skills to clarify findings without assigning blame or assuming ownership of correction.
Nice To Haves
- Two or more years of medical coding, coding audit, revenue cycle, compliance, or healthcare quality review experience.
- Coding certification such as CPC, CCS, or equivalent.
- Experience in an FQHC, community health center, or other complex healthcare revenue cycle environment.
- Experience supporting formal audit, quality assurance, or risk review processes.
Responsibilities
- Complete assigned coding audits according to approved methodology, review scope, sampling expectations, and due dates.
- Evaluate coded encounters for coding accuracy, documentation support, completeness, and alignment with coding standards and organizational requirements.
- Identify coding discrepancies, documentation gaps, repeat defects, potential compliance exposure, and revenue risk indicators during audit review.
- Document each finding with clear rationale, supporting evidence, applicable references, business context, and risk significance.
- Escalate material compliance risks, recurring coding defects, financial exposure, and ambiguous scenarios through defined escalation pathways.
- Analyze audit results to surface recurring trends, defect patterns, and systemic risk indicators for accountable leaders.
- Clarify audit findings for accountable leaders while maintaining role boundaries and avoiding ownership of correction, coding execution, provider education, or customer communication.
- Maintain audit objectivity, consistency, and professional rigor when findings are questioned, time-sensitive, or operationally complex.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
