Outpatient Coding Auditor

CGI•Atlanta, GA

12h•Remote

About The Position

CGI is seeking an experienced Outpatient Coding Auditor to join its Healthcare Compliance Audit Team. This fully remote position is open to candidates anywhere in the United States, who must be available to work Eastern Time Zone business hours. The auditor conducts comprehensive reviews of outpatient medical records and claims to identify coding discrepancies, reimbursement inaccuracies, and potential improper payments, including overpayments and underpayments. Claims may come from outpatient hospitals, ambulatory surgical centers, physician practices, and other healthcare settings. The role requires applying outpatient coding, clinical documentation, and reimbursement expertise to produce accurate, evidence-supported audit determinations and clearly documented findings. The auditor works independently while collaborating with internal teams and, when applicable, healthcare providers. CGI provides ongoing training and professional development as audit methods, regulatory requirements, and industry standards evolve. Occasional onsite provider reviews or other business-related travel may be required.

Requirements

Current professional coding certification through AHIMA or AAPC, such as RHIT, RHIA, CCS-P, CPC, or COC (formerly CPC-H).
At least five years of outpatient surgical coding experience in a facility and/or professional healthcare setting.
Extensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including modifier usage, coding conventions, and documentation requirements.
Working knowledge of CMS OPPS, APCs, NCCI edits, and OCE edits.
Ability to analyze complex medical records, interpret clinical documentation, and identify coding or reimbursement discrepancies.
Strong critical-thinking, analytical, and problem-solving skills, including the ability to make independent, evidence-based audit determinations.
Excellent written communication skills, including developing clear, accurate, well-reasoned audit narratives with appropriate supporting references.
Experience using coding encoders, electronic medical records, and remote medical record review systems.
Proficiency with Microsoft Outlook, Word, and Excel, and familiarity with Windows-based operating systems.
Strong organizational and time-management skills, ability to work independently and adapt to changing priorities, and ability to consistently meet quality and productivity standards.
Availability to work Eastern Time Zone business hours.

Nice To Haves

Outpatient surgical coding experience in orthopedics, cardiology, spine and back procedures, or interventional radiology.
Experience conducting coding audits, peer reviews, payment integrity reviews, or healthcare reimbursement compliance assessments.
Experience training, mentoring, or providing quality feedback to junior-level coders or coding professionals.
Familiarity with Charge Description Master (CDM) structures, maintenance, and reimbursement implications.
Experience using TruCode encoder software and other advanced coding or audit applications.
Experience supporting healthcare payer audits, recovery initiatives, or complex outpatient claims reviews.

Responsibilities

Conduct detailed medical record reviews to identify coding discrepancies, reimbursement inaccuracies, and payment recovery opportunities across outpatient facility, professional, and allied health claims.
Evaluate clinical documentation, coding accuracy, and reimbursement methodologies for compliance with coding standards, payer policies, and regulatory requirements.
Develop comprehensive audit findings and written rationales supported by authoritative coding references, clinical documentation, and reimbursement guidelines.
Apply ICD-10-CM, CPT, HCPCS, NCCI edits, OCE edits, and other applicable coding and payment methodologies to support audit determinations.
Interpret and apply CPT Assistant, Coding Clinic for HCPCS, NCDs, LCDs, and client-specific reimbursement and medical policies.
Collaborate with the Edit Development team on claims selection criteria, emerging coding trends, and new payment recovery concepts.
Meet established audit quality, productivity, accuracy, documentation, client, and contractual standards.
Communicate audit findings, coding interpretations, and recommendations to team leads, internal stakeholders, and healthcare providers when applicable.
Adapt to changing audit priorities, regulatory changes, and client requirements while complying with CGI policies, procedures, and operational expectations.
Participate in ongoing training and professional development, and undertake occasional onsite provider reviews or other business-related travel as required.