Job Description

Job Title: Senior Coding Quality Auditor

Location: Remote (On-site training required for first 30 days)

Schedule: Standard business hours (8:00am–4:30pm) during training; flexible hours available after training

Position Overview

The Senior Coding Quality Auditor is responsible for conducting retrospective audits to ensure compliance with internal policies, CMS regulations, OIG guidance, state Medicaid plans, and professional standards. This role plays a critical part in promoting coding and billing accuracy, supporting operational efficiency, and fostering a culture of compliance through education and collaboration.

Key Responsibilities

• Conduct retrospective audits of coding, billing, and related documentation to ensure compliance with policies, regulations, and industry standards.
• Review charge information, claim forms, insurance correspondence, and supporting documentation to validate accurate coding, billing, claim follow-up, and credit posting.
• Develop and maintain audit timelines, schedules, and reporting.
• Communicate audit findings, trends, and recommendations clearly to leadership and relevant departments.
• Provide education and feedback to physicians, leaders, and staff on documentation and coding accuracy, addressing deficiencies and errors as identified.
• Collaborate with the Manager and Corporate Compliance Department on compliance investigations involving physician groups.
• Participate in compliance investigations and assist with remediation efforts when needed.
• Attend internal and external educational programs and conferences to maintain professional development and up-to-date knowledge of coding compliance.
• Encourage membership and active participation in professional organizations such as AAPC or AHIMA.

Qualifications

Education:

• High School Diploma required

Certifications (Required):

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist – Physician-based)

Experience:

• Minimum of 3 years coding and auditing experience
• At least 5 years’ experience in a hospital or clinical setting

Skills & Competencies:

• Strong analytical, problem-solving, and organizational skills
• Excellent verbal, written, and interpersonal communication skills
• Ability to interact professionally with all levels of the healthcare team
• Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word)
• Ability to remain objective and professional in difficult situations

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