Outpatient Coding Compliance Auditor

Gebbs Healthcare Solutions Inc

3d•$36 - $36•Remote

About The Position

GeBBS Healthcare Solutions is seeking an experienced Outpatient Coding Compliance Auditor to perform comprehensive audits of acute care outpatient facility coding. This remote role focuses on ensuring coding accuracy, regulatory compliance, and appropriate reimbursement. The auditor reviews clinical documentation and coding practices, identifies discrepancies and improvement opportunities, prepares findings, and supports coding quality through education and collaboration.

Requirements

At least 4 years of acute care outpatient facility coding experience, including coding quality or compliance auditing.
Demonstrated expertise in ICD-10-CM, CPT, HCPCS Level II, and modifiers.
Active CCS, RHIA, or RHIT credential.
Strong understanding of OPPS, APC reimbursement methodologies, Medicare guidelines, and outpatient coding compliance.
Experience auditing outpatient facility encounters, procedures, and documentation accuracy.
Ability to identify coding discrepancies, compliance risks, and reimbursement opportunities.
Strong analytical, communication, and written reporting skills.
Experience providing coding feedback, education, and quality improvement recommendations.
Ability to work independently and collaborate effectively with remote teams.
Proficiency with Epic EHR.

Nice To Haves

Bachelor's degree in Health Information Management, Healthcare Administration, or a related field, or equivalent experience.
Experience using iCodeOne or similar coding audit platforms.
Experience auditing multiple outpatient service areas, such as emergency department, observation, same-day surgery, or ancillary services.

Responsibilities

Conduct comprehensive audits of acute care outpatient medical records using iCodeOne to validate ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
Review outpatient facility services, procedures, and clinical documentation for coding accuracy and completeness.
Evaluate coding practices for compliance with CMS, OIG, AHIMA, AAPC, payer-specific, and client requirements.
Review outpatient reimbursement accuracy, including OPPS, APC assignments, and applicable Medicare guidelines.
Identify coding errors, documentation gaps, compliance risks, and reimbursement opportunities.
Prepare detailed audit reports outlining findings, recommendations, and corrective actions.
Collaborate with coding leadership, clinical teams, and operational departments to resolve discrepancies and improve documentation quality.
Provide individualized and group education to coders based on audit findings and regulatory updates.
Analyze coding quality trends and recommend strategies to improve accuracy, compliance, and overall performance.
Stay current on outpatient coding guidelines, CPT and HCPCS updates, Medicare reimbursement methodologies, and regulatory requirements.