Conduct comprehensive audits of professional evaluation and management services, inpatient, emergency room, minor procedures, consultation services, and annual wellness service encounters
Review and analyze provider documentation for completeness and accuracy to ensure proper code assignment in accordance with CPT, HCPCS, ICD-10-CM, and CMS guidelines
Utilize various encoders and coding tools/resources (e.g., decisionhealth, 3M, AMA, CMS) to validate code selection and support audit findings
Prepare detailed audit reports, summarizing findings, trends, and recommendations for education or process improvement
Remain current with changes in coding guidelines, payer policies, and industry trends impacting Evaluation & Management services
Assist with internal and external audit responses and appeals as needed
Support compliance initiatives and contribute to ongoing process improvement within the coding and auditing team

Current coding certification (e.g., CPC, CCS-P, CPMA, and/or COC)
Minimum 3 years of recent experience in professional fee coding and auditing, with demonstrated expertise in inpatient E/M, minor procedures, emergency room, consultation, and annual wellness services
Strong working knowledge of CPT, ICD-10-CM, HCPCS, CMS guidelines, and payer policies
Proficient in the use of encoders and coding resources (such as 3M, Optum, AAPC, AMA)
Excellent analytical, organizational, and communication skills
Ability to work independently and collaboratively in a team environment
Strong attention to detail

Medical Coding Auditor – Evaluation & Management

Key skills