Medical Coding Auditor

By adhering to Connecticut State Law, pay ranges are posted. The pay rate will vary based on various factors including but not limited to experience, skills, knowledge of position and comparison to others who are already in this role within the company.

Proof of annual flu vaccination is required for all employees.

is a management service organization that supports a large multi-specialty practice of providers. We are currently looking for an experienced Medical Coding Auditor who will be working in Branford Monday through Friday from 8:30am to 5:00pm. This is not a remote position.

The Medical Auditor is responsible for coordinating and conducting medical billing, coding, and documentation audits to ensure compliance with federal, state, and commercial payer regulations, organizational policies, and industry standards. This role evaluates provider documentation, coding accuracy, billing practices, and revenue cycle processes across multiple clinical specialties and care settings. The Medical Auditor provides education, consultation, and recommendations to clinicians, clinical staff, and operational leaders to improve documentation integrity, coding accuracy, regulatory compliance, and revenue optimization.

This position works closely with physicians, advanced practice providers, coding and billing personnel, revenue cycle leadership, compliance officers, operational leaders, and other healthcare stakeholders to promote compliant documentation, coding, billing, and reimbursement practices.

• Conduct routine and focused audits of medical records, provider documentation, coding, billing, and reimbursement practices in accordance with the Compliance Work Plan and departmental priorities.
• Perform independent reviews of professional, outpatient, inpatient, home health, skilled nursing facility, and other healthcare service documentation to assess compliance with applicable regulations and payer requirements.
• Evaluate provider documentation for ICD-10, CPT, HCPCS, and E/M coding accuracy and compliance with organizational, governmental, and payer guidelines.
• Validate charges and billing activity against supporting medical record documentation.
• Review encounter forms, charge documents, operative reports, procedural reports, medical records, and billing workflows to identify compliance risks and coding opportunities.
• Participate in audits conducted or requested by government agencies, commercial payers, or other third-party entities.

• Analyze audit findings, identify trends, control deficiencies, documentation gaps, and compliance vulnerabilities.
• Prepare detailed audit work papers, reports, and supporting documentation in accordance with established standards.
• Develop and maintain audit tracking logs, databases, dashboards, and reports to monitor audit activities and corrective action progress.
• Utilize data analysis and reporting tools to identify billing trends, high-risk areas, and opportunities for focused reviews.
• Present findings and recommendations to compliance leadership, department management, and other stakeholders.

• Collaborate with operational and clinical leaders to develop corrective action plans addressing identified audit findings.
• Monitor implementation and effectiveness of corrective actions and validate sustained compliance improvements.
• Conduct education and training sessions for physicians, providers, coders, billers, and clinical staff on coding, documentation, compliance, and regulatory requirements.
• Assist in the development of training materials, compliance resources, and educational programs.
• Serve as a subject matter expert regarding coding, billing, documentation, and compliance requirements.

• Assist with investigations related to compliance concerns, hotline reports, and potential billing or documentation issues.
• Support the development, revision, and implementation of compliance policies and procedures.
• Participate in enterprise risk assessments and compliance monitoring activities to support annual audit planning.
• Contribute to ongoing compliance program initiatives and organizational efforts to promote ethical billing and coding practices.
• Remain current on regulatory changes, payer updates, coding revisions, and industry best practices affecting healthcare reimbursement and compliance.

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