Lead - Healthcare - Coding Quality Auditor

📋 Description

• Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient
• Review medical documentation to validate the accuracy and completeness of assigned diagnosis and
• Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial
• 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

🎯 Requirements

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