Certified Professional Medical Coding Auditor

As aCertified Professional Medical Coding Auditor, your work at Tegriawill focus on evaluating the accuracy, consistency, and quality of coded medical records completed by internal and external coding staff, conducting routine monthly and targeted audits to ensure adherence to official coding guidelines, payer requirements, regulatory standards, and organizational policies.

This role completes audits, applying established coding guidelines and audit procedures to resolve most coding questions independently. The role may recommend improvements to coding procedures as guidelines and requirements evolve, escalates findings that may signal a compliance or revenue concern to coding leadership for evaluation, and provides supporting documentation that leadership relies on whendeterminingnext steps.

The auditoridentifiescoding trends and improvement opportunities from completed audits and shares them with coding leadership. Partnering with the Coding Manager and Coding Leads, this role delivers clear, constructive feedback and helps support coder development, while championing accuracy, compliance, and revenue integrity throughout the organization.

An effective

Certified Professional Medical Coding Auditor will help the organization on a whole achieve success through:

• Living our Tegriavalues:
  Respect Every Person, Act with Integrity, Strive for Better, Embrace Change, Deliver as a Team

• Conduct audits according to the audit plan andmethodologyestablishedby coding leadership, applying sound judgment within defined parameters.

• Conduct retrospective and concurrent audits of coder-assigned ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and modifier codes.

• Evaluate coding accuracy, completeness, consistency, and compliance with official coding guidelines and organizational standards.

• Perform routine monthly quality assurance audits as well as focused reviews assigned by coding leadership.

• Validate appropriate code assignment and sequencing based on provider documentation.

• Apply sound coding judgment to resolve routine coding questions, escalating more complex or ambiguous coding requirements to a senior auditor or coding leadership for guidance.

• Identify coding errors, trends, and opportunities for process improvement; flag potential compliance or revenue concerns to coding leadership for evaluation.

• Monitor coding quality metrics andassistleadership with accuracy of scorecard development and reporting.

• Participate in quality improvement initiatives designed to enhance coding performance and consistency across teams.

• Provide timely, constructive, and individualized feedback to codersregardingaudit findings.

• Translate audit findings and coding trends into topics for education sessions andidentifydevelopmental needs, in partnership with coding leadership.

• Contribute to and help deliver coding education sessions based on audit results,identified trends, and regulatory updates.

• Create educational resources including tip sheets, coding guidance documents, case studies, and training materials.

• Assist with onboarding and mentoring newly hired coders.

• Partner with coding leadership to support corrective action plans and individualized education plans when needed.

• Serve as a coding resource for staff andassistcoders with complex coding questions.

• Ensure coding practices comply withICD-10-CM, CPT, HCPCS, CMS, Official Coding Guidelines, and payer requirements.

• Recommend updates to coding procedures and guidance documents as guidelines, payer requirements, or organizational needs evolve.

• Monitor regulatory and coding guideline changes and communicate their impactoncoding staff and leadership.

• Escalate audit findings and potential…