Full employer posting
Location: Remote Sutter Provides all Equipment
- 5+ years of professional coding, billing, or healthcare audit experience, including risk-based auditing
- Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, bundling, and current E/M guidelines
- Experience with Medicare, Medi-Cal, commercial payer policies, CMS manuals, NCDs/LCDs, and payer-specific billing requirements
- Experience conducting prospective and retrospective audits validating coding, documentation, medical necessity, and modifier usage
- Proficiency in Epic charge review, claim/edit workflows, workqueues, coding documentation, and billing documentation
- Experience identifying overcoding, undercoding, unbundling, unsupported services, documentation deficiencies, and compliance risks
- Ability to analyze audit results, error rates, financial impact, coding trends, and recurring root causes
- Ability to develop defensible audit samples, maintain consistent audit decisions, and support inter-rater reliability
- Ability to translate complex coding findings into clear, defensible reporting and education for physicians and APCs
- Experience researching authoritative coding guidance including CPT Assistant, Coding Clinic, CMS guidance, and payer policies
Preferred
- Experience with MD audit software, including audit management, findings tracking, trending, and reporting
- Experience quantifying underpayments, overpayments, missed revenue, and compliance exposure
- Ability to distinguish individual coding errors from systemic workflow, Epic build, documentation, or training issues
- Experience recommending provider education, workflow changes, Epic changes, edit development, or ongoing monitoring
- Experience using utilization, reimbursement, coding patterns, and historical findings to prioritize high-risk providers or services
- Ability to quickly incorporate annual CPT/ICD updates, CMS rule changes, and payer-policy updates
Summary / Duties: The Coding Auditor conducts risk-based prospective and retrospective audits across professional coding and billing workflows. Responsibilities include validating code assignment, documentation, medical necessity, modifier usage, E/M coding, bundling, and payer-specific requirements. The auditor will use Epic workflows and MD audit reporting tools to identify coding and compliance risks, analyze error trends and financial impact, and determine root causes.
This role develops appropriate audit samples, maintains defensible and consistent audit documentation, and communicates findings clearly to physicians and APCs. The auditor will also recommend education, workflow improvements, Epic or edit changes, and monitoring strategies while managing multiple concurrent audits, reporting deadlines, and evolving CMS, CPT, ICD-10-CM, and payer requirements.
About the role
The Coding Auditor conducts risk-based prospective and retrospective audits across professional coding and billing workflows. Responsibilities include validating code assignment, documentation, medical necessity, modifier usage, E/M coding, bundling, and payer-specific requirements.