External Auditor Physician
About The Position
We are seeking an experienced External Auditor Physician with a minimum of 3 years of experience auditing professional fee coding, particularly in Evaluation & Management (E/M) and procedures across multiple specialties. This role requires expertise in radiology, neuro, and ortho at a trauma 1 facility. Epic experience is mandatory, and Codify experience is preferred. The schedule is Monday-Friday, with core hours preferably between 8 am and 5 pm CST, though the start time can be flexible. During the first week of training, candidates must be available from 8 am to 5 pm CST.
Requirements
- Minimum of 3 years' experience auditing professional fee coding across multiple specialties.
- Advanced proficiency in CPT, HCPCS Level II, and ICD-10-CM coding guidelines.
- Strong expertise in Evaluation & Management (E/M) coding (office, hospital, consults, ED, critical care).
- Extensive experience auditing procedure-based coding across multiple specialties (e.g., cardiology, orthopedics, radiology, neurosurgery, general surgery).
- In-depth knowledge of NCCI edits, MUEs, modifier usage, and bundling/unbundling rules.
- Strong knowledge of CMS guidelines, payer policies, and federal/state compliance requirements.
- Familiarity with OIG Work Plan, audit risk areas, and regulatory updates.
- Strong understanding of clinical documentation requirements to support both E/M and procedural services.
- Working knowledge of medical terminology, anatomy, physiology, and disease processes across specialties.
- Epic experience required.
- Able to work M-F with the majority of the shift between 8a-5p CST.
- Able to pick up new workflows and technology easily.
- Able to ramp up productivity in 4 weeks.
- Maintain 95% accuracy in all coding.
- Good written and verbal communication skills.
Nice To Haves
- Codify experience preferred.
- Experience auditing radiology, neuro, and ortho at a trauma 1 facility.
- Experience supporting internal and external audits, including payer audits and RAC reviews.
- Strong presentation skills for delivering education sessions and audit results.
Responsibilities
- Conduct retrospective and concurrent coding audits for professional fee services.
- Evaluate and validate medical necessity and accurate code assignment.
- Interpret specialty-specific documentation and apply appropriate coding rules.
- Identify coding trends, compliance risks, and revenue leakage.
- Calculate and report accuracy rates, error categorization, and financial impact.
- Develop audit reports, scorecards, and executive summaries.
- Create and deliver education and feedback to coders and providers.
- Support internal and external audits, including payer audits and RAC reviews.
- Identify documentation gaps and provide actionable recommendations.
- Clearly communicate audit findings, rationale, and coding guidelines to stakeholders.
- Collaborate with providers, coding teams, CDI, and operational leadership.
- Present audit results and deliver education sessions.
- Mentor and guide coders to improve quality and compliance performance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
