Surgical Coding Auditor

Position Summary  

The Coding Auditor conducts internal coding audits across assigned specialties and accounts to assess coding accuracy, documentation sufficiency, and compliance with applicable coding guidelines and payer requirements. This role produces well-documented audit findings, supports corrective action follow-through, and contributes to the department's compliance monitoring and education efforts. The Coding Auditor works closely with the Senior Coding Auditor and Coding Compliance & Audit Manager to develop technical skills, deliver consistent audit quality, and grow into an increasingly independent contributor within the audit program.  

Key Responsibilities  

Audit Execution  

• Conduct routine coding audits across assigned specialties and client accounts, reviewing clinical documentation and coded encounters for accuracy, documentation alignment, and compliance with applicable guidelines  
• Apply ICD-10-CM, CPT, HCPCS, modifier rules, and payer-specific requirements to audit findings; support all determinations with clearly cited, authoritative references  
• Complete assigned audit volumes within established turnaround expectations and quality standards  
• Escalate complex or unclear coding scenarios to the Senior Coding Auditor for guidance and resolution  

Finding Documentation & Reporting  

• Document audit findings with accuracy and clarity, including discrepancy identification, root cause classification, and corrective recommendations  
• Prepare individual audit reports and summary submissions in accordance with department templates and standards  
• Maintain organized, complete audit records and files in accordance with department documentation requirements  
• Compile audit data for submission to the Coding Compliance & Audit Manager for trend analysis and reporting  

Corrective Action & Education Support  

• Communicate audit findings to audited coders in a professional, constructive, and guideline-grounded manner  
• Support delivery of audit-driven education, including written feedback, reference materials, and participation in team huddles or education sessions  
• Assist in re-auditing previously identified findings to assess corrective action effectiveness  
• Identify patterns in assigned audit findings and report observations to the Coding Compliance & Audit Manager and Senior Coding Auditor  

Compliance Monitoring  

• Remain current with applicable coding guidelines, payer updates, and regulatory requirements relevant to assigned specialties  
• Flag potential compliance risks or emerging accuracy issues identified during audit activity to the Senior Coding Auditor or Coding Compliance & Audit Manager  
• Support audit readiness activities and contribute to audit program documentation as directed  

Qualifications  

• 3+ years of professional medical coding experience across at least one specialty  
• Active coding credential required (CPC, CCS, CIC, or equivalent); CPMA or audit-focused credential preferred or actively pursued  
• Working knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and applicable payer coding requirements  
• Strong attention to detail with the ability to produce clearly documented findings supported by authoritative references  
• Effective written communication skills; professional and constructive in delivering feedback  

Originally posted on Himalayas