Lead - Healthcare - Coding Quality Auditor

The Medical Coding Auditor is responsible for keeping Sutherland coders in compliance by reviewing medical records and coding practices to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in compliance with federal, state, payer, and organizational guidelines. This role evaluates coding accuracy, identifies documentation deficiencies, conducts audits, provides education to coding staff and providers, and supports revenue cycle integrity while minimizing compliance risk.
Essential Duties and Responsibilities

- Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and/or specialty services.

- Review medical documentation to validate the accuracy and completeness of assigned diagnosis and procedure codes.

- Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines.

- Identify coding errors, documentation gaps, and reimbursement opportunities.

- Prepare detailed audit reports outlining findings, trends, recommendations, and corrective actions.

- Provide one-on-one and group education to coders, providers, and clinical staff regarding coding updates, documentation improvement, and compliance requirements.

- Monitor coding quality metrics and develop action plans to improve coding accuracy and consistency.

- Stay current on coding regulations, Official Coding Guidelines, CMS regulations, payer policies, and industry best practices.

- Assist with internal and external audits, payer reviews, and regulatory investigations.

- Maintain confidentiality of protected health information (PHI) in accordance with HIPAA regulations.

- Participate in policy development, process improvement initiatives, and coding education programs.

- Track audit results and identify recurring trends to support continuous quality improvement.

Qualifications

- Minimum of 3-5 years of medical coding experience in a healthcare setting.

- Minimum of 2 years of coding audit or quality review experience preferred.

- Current coding certification such as:

- Certified Professional Coder (CPC)

- Certified Professional Medical Auditor (CPMA)

- Certified Coding Specialist (CCS)

- Certified Inpatient Coder (CIC)

- Registered Health Information Technician (RHIT) or

- Registered Health Information Administrator (RHIA) preferred

- Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems.

- Strong understanding of CMS regulations, National Correct Coding Initiative (NCCI), Official Coding Guidelines, and payer-specific policies.

- Experience with electronic health records (EHR) and encoder software.

Knowledge, Skills, and Abilities

- Exceptional analytical and critical thinking skills.

- Strong knowledge of healthcare reimbursement methodologies.

- Ability to interpret complex clinical documentation.

- Excellent written and verbal communication skills.

- Strong attention to detail and organizational abilities.

- Ability to maintain objectivity while providing constructive feedback.

- Proficiency with Microsoft Office Suite and coding/audit software.

- Ability to work independently and collaboratively in a fast-paced environment.

All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation

During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is o