RCS Medical Coding Auditor (CPC, CPMA)

Veradigm•Raleigh, NC

22d

About The Position

The RCS Medical Coding Auditor is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback. The ideal candidate brings strong hands-on experience with professional fee coding, deep knowledge of E/M, surgical, and modifier use, and the ability to translate audit findings into actionable insights.

Requirements

CPC (Required) and CPMA (Required/In Process)
2+ years of ProFee auditing experience
Knowledge of E/M documentation guidelines
Knowledge of Modifier rules and NCCI edits
Knowledge of CPT, ICD‑10‑CM, HCPCS Level II
High attention to detail with strong analytical and critical‑thinking skills
Excellent written and verbal communication skills for audit reporting and education
Proficiency with EHRs, coding and auditing tools
Proficiency with Microsoft Office Suite

Nice To Haves

Multi-specialty coding and auditing experience with preferred background in E/M Coding, Orthopedics, Pain Management, Urology
Background in coding quality programs or compliance teams
Advanced reporting skills for audit tracking and trend analysis
Prior consulting or client‑facing audit experience

Responsibilities

Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback
Validate ICD‑10‑CM, CPT®, HCPCS, and modifier assignment against clinical documentation to ensure accuracy and compliance with AMA CPT, ICD-10, CMS, NCCI, and payer-specific guidelines
Conduct medical chart audits of professional services across multiple specialties
Identify coding discrepancies, compliance risks, trends, root causes, and documentation gaps
Support coding education through feedback, targeted training, and reference materials
Prepare clear, defensible audit documentation including rationale and references
Provide actionable recommendations to address audit findings and reduce future risk
Track audit outcomes and trends to support leadership reporting and risk mitigation strategies
Support denial prevention, resolution and appeal strategies
Collaborate across teams to assist with coding support
Maintain confidentiality and comply with HIPAA and organizational policies