Medical Coding Auditor (Outpatient)

Accountabilities

• • Review outpatient medical records and extract relevant clinical information to determine accurate procedural and diagnostic coding.
  • Assign and validate appropriate medical codes, including ICD-10-CM and CPT, in accordance with applicable coding conventions and standards.
  • Conduct detailed outpatient medical record audits to identify coding discrepancies, documentation issues, and opportunities for correction.
  • Apply knowledge of NCDs, LCDs, CMS Manuals, NCCI Edits, and other applicable coding guidelines when evaluating records and claims.
  • Read and interpret claims information to assess coding accuracy and support appropriate claims outcomes.
  • Exercise independent judgment and discretion when determining the appropriate course of action for complex or varied audit findings.
  • Manage multiple assignments and priorities in a production-based, metric-driven environment while maintaining accuracy and productivity.
  • Document audit findings clearly and communicate relevant information through strong written and verbal communication.
  • Support appeals, disputes, financial recovery, and other auditing activities when required.
  • Use coding, claims, and operational systems to research and complete audit assignments efficiently.
  • Maintain confidentiality and handle protected health information in accordance with applicable privacy and security requirements.
  • Contribute to a collaborative, quality-focused environment while working independently and meeting established performance expectations.

  Requirements

  • Active CPC, COC, CCS, RHIA, or RHIT certification with at least 3 years of post-certification experience.
  • Minimum of 2 years of experience performing outpatient medical record audits, with demonstrated knowledge of outpatient coding conventions and standards.
  • Strong working knowledge of NCDs, LCDs, CMS Manuals, NCCI Edits, and applicable coding guidelines.
  • Demonstrated ability to exercise sound judgment, discretion, and independent decision-making when reviewing sensitive or complex information.
  • Strong attention to detail and the ability to identify coding discrepancies while maintaining consistent quality.
  • Ability to work independently, manage workload effectively, and prioritize multiple assignments in a production-oriented environment.
  • Strong analytical, organizational, time-management, written, and verbal communication skills.
  • Working knowledge of Microsoft Office applications, particularly Word and Excel.
  • Preferred experience includes 5+ years of coding experience and at least 3 years of experience reading and interpreting claims.
  • Experience with outpatient facility auditing, 3M Coder, CRM/SRO, Pareo, or MOAT is advantageous.
  • Experience with appeals and disputes auditing, financial recovery, or fast-paced, metric-driven operations is a plus.
  • Advanced or specialty coding certifications are preferred.
  • Ability to work standard business hours Monday through Friday, with daily start times between 6:00 AM and 9:00 AM EST, regardless of home time zone.

  Benefits

  • Salary: $59,300–$80,900 per year, with compensation varying based on location, skills, experience, education, certifications, and other job-related factors.
  • Bonus: Eligibility for a performance-based bonus incentive plan.
  • Healthcare: Medical, dental, and vision coverage.
  • Retirement: 401(k) retirement savings plan.
  • Paid time off: Paid time off, personal and company holidays, and paid parental and caregiver leave.
  • Insurance: Short-term and long-term disability coverage and life insurance.
  • Remote work: Fully remote position within the United States, with flexibility within established business-hour requirements.
  • Home-office support: Telephone equipment appropriate to business needs and potential bi-weekly internet expense support for eligible employees in California, Illinois, Montana, and South Dakota.
  • Work environment: Dedicated home workspace required to protect confidential member information, with reliable internet service.
  • Schedule: Full-time, 40 hours per week, generally Monday through Friday.
  • Travel: Occasional travel for training or meetings may be required.