Medical Coding Auditor

Become a part of our caring community and help us put health first

The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments.

The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy and operating objectives, and follows established guidelines and procedures while making decisions in ambiguous situations.

The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing accuracy of provider contract payments and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy, operating objectives, and follows established guidelines and procedures.

As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered.
• Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding.
• Utilize encoders and various coding resources.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed.
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information.
• Maintain current working knowledge of ICD‑10 and CPT coding guidelines, government regulation and protocols.
• Complete appropriate system entries regarding claim/encounter information.
• Support and participate in process and quality improvement initiatives.

We offer remote work. As a Fortune 100 Company, we value associate engagement and well‑being, and provide excellent professional development & continued education.

100% work at home / remote.

Typical business hours are Monday‑Friday, 8 hours/day, 5 days/week – some flexibility may be possible depending on business needs.

• Minimum of 3 years post‑certification experience and certification with CPC, COC, CCS, ROCC, RHIA or RHIT.
• Experience with outpatient specialty surgeries and procedures.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading & coding from operative reports.
• Chemotherapy/therapeutic infusion experience.
• Solid judgment and discretion in handling and disseminating information.
• Strong attention to detail, ability to work independently and handle multiple priorities.
• Comfortable working in a production‑based work environment.
• Strong written and verbal communication skills; strong analytical, organizational and time‑management skills.
• Working knowledge of Microsoft Office (Word, Excel).

• 5+ years prior coding experience.
• Minimum of 3 years post‑certification experience reading and interpreting claims.
• Outpatient facility auditing experience.
• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology.
• Ambulatory Payment Classification (APC) coding experience.
• Radiation Oncology coding experience.
• Experience in prospective…