Coding Compliance Audit Specialist

Under indirect supervision, the Coding Compliance Audit Specialist conducts baseline, routine, and focused audits by comparing medical record documentation with reported CPT, HCPCS, and ICD-10-CM codes. Successful candidates will have extensive coding audit experience, strong knowledge of CMS and Medicare guidelines, and the ability to interpret and communicate federal and state regulations while serving as an internal expert on coding compliance. CPC and CPMA certifications are required.

• Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines.
• Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.
• Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
• Other duties as assigned

• 5+ years of audit experience is preferred.
• Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines.
• Certified Professional Coder (CPC) required and Certified Professional Medical Auditor (CPMA)
• Experience working with MDAudit and Athena is a plus.
• Must comply with all HIPAA rules and regulations.
• Excellent communication skills and the ability to work independently.