Remote - Professional Coding Auditor

Description

This position ensures the accuracy, completeness, and compliance of medical coding and clinical documentation for professional coding services. The role supports accurate coding practices, appropriate reimbursement, and regulatory compliance by reviewing patient records and collaborating with healthcare providers, coding teams, and compliance staff.

RESPONSIBILITIES

• Ensures the accuracy, completeness, and compliance of medical coding and documentation for professional coding services.• Reviews patient records, clinical documentation, and coded data to identify discrepancies and coding issues.• Works closely with healthcare providers, coders, and compliance teams to support accurate professional coding practices.• Supports appropriate reimbursement and mitigates compliance risks through detailed coding reviews.• Conducts comprehensive chart reviews to evaluate coding accuracy and documentation quality.• Evaluates provider documentation to ensure appropriate coding and regulatory compliance.• Participates in routine audits to maintain high standards of coding accuracy and compliance.• Provides education and training to healthcare professionals regarding coding standards and documentation improvement.• Analyzes coding data to identify trends, opportunities for improvement, and compliance risks.• Generates audit reports summarizing findings and recommendations.

AUDIT AND REVIEW

• Conducts regular audits of medical coding to verify accuracy, completeness, and compliance with ICD-10, CPT, HCPCS, and other coding systems.• Evaluates coding practices against payer guidelines, regulatory requirements, and internal organizational policies.

COMPLIANCE MONITORING

• Ensures adherence to federal and state regulations including CMS guidelines and HIPAA standards.• Identifies discrepancies or violations and recommends corrective actions.

REPORTING AND DOCUMENTATION

• Prepares detailed audit reports outlining findings, trends, and recommendations for improvement.• Documents audit procedures, results, and issues in a clear and organized manner.

STAY CURRENT

• Maintains up-to-date knowledge of coding guidelines, healthcare regulations, and industry best practices.• Participates in relevant workshops, seminars, and continuing education programs as required.

MINIMUM QUALIFICATIONS

• High school diploma or equivalent required.• Two years of post-secondary education in a business or medical-related field preferred.• Two years of experience in a medical billing or coding office required; medical management experience preferred.• Equivalent combinations of education and experience may be considered.• Coding certification through a nationally recognized organization such as AAPC or AHIMA required (CCS-P, CPC, RHIA, RHIT, CCS, CPC-H).

• Minimum of two years of experience working in a medical billing, coding, or healthcare revenue cycle environment preferred.• Experience with medical coding, auditing, or chart review in a healthcare setting preferred.• Familiarity with electronic health record (EHR) systems preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong knowledge of medical terminology, anatomy, and coding systems.• Strong written and verbal communication skills.• Thorough understanding of healthcare regulations and compliance standards.• Excellent attention to detail and accuracy in documentation review.• Ability to analyze coding data and identify discrepancies or improvement opportunities.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact ’s Human Resources at . Please note that one week's advance notice is preferred.