Quality Auditor - Medical Coding

Key Responsibilities

• Perform quality reviews of ASC and professional surgical coding, including CPT, ICD-10-CM, modifier assignment, and compliance with Official Coding Guidelines, NCCI/OCE edits, and payer policies
• Support and maintain the coding quality assurance program, including audit methodologies, scoring, documentation standards, and quality tracking processes
• Analyze audit results and quality trends to identify risk areas, educational needs, and opportunities for process improvement
• Develop and deliver targeted coder education, including remediation, training sessions, and client-specific education as needed
• Prepare client-facing audit summaries and reports that communicate quality scores, trends, and recommended actions clearly and professionally
• Collaborate with Coding Operations and cross-functional teams to support workflow optimization, standardization of best practices, and achievement of quality and service-level expectations
• Provide expert-level support for complex coding questions across Ambulatory Surgery Centers and Professional Fee Services
• Participate in quality and compliance initiatives, including follow-up audits, monitoring of corrective actions, and validation of improvement outcomes
• Contribute to special projects related to audits, quality improvement, workflow enhancements, client onboarding, and ongoing client support

• Credentials: Active AAPC or AHIMA credential (CPC, CCS, RHIT, or RHIA required)
• 8 -10+ years of coding experience, including outpatient and/or professional surgical coding
• 5+ years of coding quality auditing and/or coding education experience.
• Advanced knowledge of CPT, ICD-10-CM, modifier usage, Medicare regulations, OPPS, and payer policies.
• Experience with multiple surgical specialties such as orthopedics, spine, pain management, ophthalmology, and general surgery
• Strong written and verbal communication skills, including education and presentation capabilities
• Excellent analytical skills with the ability to interpret audit data and translate findings into actionable education
• Highly organized with the ability to manage multiple priorities and meet deadlines in a fast-paced, remote environment
• Self-directed, solution-oriented mindset with strong critical thinking and problem-solving abilities
• Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint