Professional Coding Auditor

Emory•Atlanta, GA

About The Position

This position ensures the accuracy, completeness, and compliance of medical coding and clinical documentation for professional coding services. The role supports accurate coding practices, appropriate reimbursement, and regulatory compliance by reviewing patient records and collaborating with healthcare providers, coding teams, and compliance staff.

Requirements

High school diploma or equivalent required.
Two years of experience in a medical billing or coding office required.
Coding certification through a nationally recognized organization such as AAPC or AHIMA required (CCS-P, CPC, RHIA, RHIT, CCS, CPC-H).
Strong knowledge of medical terminology, anatomy, and coding systems.
Strong written and verbal communication skills.
Thorough understanding of healthcare regulations and compliance standards.
Excellent attention to detail and accuracy in documentation review.
Ability to analyze coding data and identify discrepancies or improvement opportunities.

Nice To Haves

Two years of post-secondary education in a business or medical-related field preferred.
Medical management experience preferred.
Equivalent combinations of education and experience may be considered.
Minimum of two years of experience working in a medical billing, coding, or healthcare revenue cycle environment preferred.
Experience with medical coding, auditing, or chart review in a healthcare setting preferred.
Familiarity with electronic health record (EHR) systems preferred.

Responsibilities

Ensures the accuracy, completeness, and compliance of medical coding and documentation for professional coding services.
Reviews patient records, clinical documentation, and coded data to identify discrepancies and coding issues.
Works closely with healthcare providers, coders, and compliance teams to support accurate professional coding practices.
Supports appropriate reimbursement and mitigates compliance risks through detailed coding reviews.
Conducts comprehensive chart reviews to evaluate coding accuracy and documentation quality.
Evaluates provider documentation to ensure appropriate coding and regulatory compliance.
Participates in routine audits to maintain high standards of coding accuracy and compliance.
Provides education and training to healthcare professionals regarding coding standards and documentation improvement.
Analyzes coding data to identify trends, opportunities for improvement, and compliance risks.
Generates audit reports summarizing findings and recommendations.
Conducts regular audits of medical coding to verify accuracy, completeness, and compliance with ICD-10, CPT, HCPCS, and other coding systems.
Evaluates coding practices against payer guidelines, regulatory requirements, and internal organizational policies.
Ensures adherence to federal and state regulations including CMS guidelines and HIPAA standards.
Identifies discrepancies or violations and recommends corrective actions.
Prepares detailed audit reports outlining findings, trends, and recommendations for improvement.
Documents audit procedures, results, and issues in a clear and organized manner.
Maintains up-to-date knowledge of coding guidelines, healthcare regulations, and industry best practices.
Participates in relevant workshops, seminars, and continuing education programs as required.