Lead - Healthcare - Coding Quality Auditor

Sutherland
New Jersey
Workplace: RemoteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3-5 yearsSkills: ["Analytical thinking","Critical thinking","Written communication","Verbal communication","Attention to detail"]

Audit medical coding quality and compliance by reviewing inpatient, outpatient, physician, and specialty documentation to ensure accurate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II code assignment. Conduct retrospective, concurrent, and prospective audits, identify documentation gaps and reimbursement opportunities, and produce detailed reports with corrective actions. Educate coders, providers, and clinical teams, track coding quality metrics, and stay current on CMS, payer, and regulatory policies while supporting audits and PHI confidentiality.

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FursaFursa
Sutherland
Sutherland
2 days ago

Lead - Healthcare - Coding Quality Auditor

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Last checked: 3 hours agoStatus: Live

Job Summary

Audit medical coding quality and compliance by reviewing inpatient, outpatient, physician, and specialty documentation to ensure accurate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II code assignment. Conduct retrospective, concurrent, and prospective audits, identify documentation gaps and reimbursement opportunities, and produce detailed reports with corrective actions. Educate coders, providers, and clinical teams, track coding quality metrics, and stay current on CMS, payer, and regulatory policies while supporting audits and PHI confidentiality.
Location: New Jersey
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and specialty services.
  • •Review medical documentation to validate accuracy and completeness of diagnosis and procedure code assignments.
  • •Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, and federal/state/payer/organizational guidelines.
  • •Identify coding errors and documentation gaps, and prepare audit reports with findings, trends, and corrective actions.
  • •Provide education to coders, providers, and clinical staff; monitor coding quality metrics and stay current on regulations and payer policies.

Key Requirements

  • •Minimum 3-5 years of medical coding experience in a healthcare setting.
  • •Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems.
  • •Strong understanding of CMS regulations, NCCI, Official Coding Guidelines, and payer-specific policies.
  • •Experience with electronic health records (EHR) and encoder software.
  • •Current coding certification such as CPC, CPMA, CCS, CIC, or RHIT/RHIA (RHIT/RHIA preferred).
Experience:3-5 yearsHealthcareMedical coding
Skills:Analytical thinkingCritical thinkingWritten communicationVerbal communicationAttention to detail
Certifications:CPCCPMACCSCICRHITRHIA
Languages:English
Tech Stack:ICD-10-CMICD-10-PCSCPTHCPCS Level IIMedicareMedicaidCMSNCCIEHREncoder softwareMicrosoft Office Suite

Company Brief

Sutherland
Global digital transformation and business process services firm offering AI, automation, cloud engineering, analytics and customer experience solutions to enterprises across industries.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Funding: Private Equity Backed
Headquarters: Pittsford (Rochester), NY, United States
Founded: 1986
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