E/M Coding Auditor

Accountabilities:

In this role, you will conduct E/M coding audits, document results, and help improve coding accuracy and compliance across assigned specialties and accounts. Your responsibilities will include:

• Perform routine E/M coding audits by reviewing clinical documentation and coded encounters for accuracy, completeness, and compliance with applicable guidelines.

• Assess the alignment between clinical documentation and reported E/M codes, including patient status, place of service, medical decision-making (MDM), total time, modifiers, and add-on or prolonged services.

• Apply AMA CPT E/M guidelines, CMS policies, ICD-10-CM, HCPCS, modifier rules, and payer-specific requirements to audit findings, using authoritative references in accordance with departmental guidance.

• Complete assigned audits within established turnaround times and quality standards, working independently within approved audit methodologies and escalating complex cases or conflicting guidance when needed.

• Participate in audit calibration activities to support consistent interpretation and application of coding guidelines.

• Document audit findings clearly and accurately, identifying discrepancies such as over-coding or under-coding, classifying root causes, and recommending corrective actions.

• Prepare individual audit reports and summary submissions, maintain complete audit records, and compile data such as E/M level distributions and accuracy rates for trend analysis.

• Communicate findings constructively to providers and coders, provide individualized coding and documentation feedback, and support educational activities through written guidance, reference materials, team huddles, and training sessions.

• Re-audit previously identified issues to evaluate corrective action effectiveness and identify recurring patterns, documentation gaps, or unusual service-level trends.

• Monitor relevant coding guideline updates, CMS and payer requirements, and regulatory changes; escalate potential compliance risks and contribute to audit readiness activities.

• Protect confidential information and safeguard protected health information in accordance with HIPAA, organizational policies, and applicable regulations.

• Meet performance expectations for audit completion, turnaround time, finding accuracy, escalation quality, feedback effectiveness, corrective action follow-through, and adherence to established audit standards.

Requirements:

The successful candidate will bring strong E/M coding expertise, practical audit experience, and the ability to communicate findings clearly while managing competing priorities. Required qualifications and skills include:

• Active Certified Professional Medical Auditor (CPMA) certification, plus at least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

• At least 5 years of E/M coding experience, including a minimum of 1 year of coding audit experience; 2 or more years of audit experience is preferred.

• Working knowledge of current AMA CPT E/M guidelines and CMS documentation requirements.

• Proficiency with Microsoft Office applications, including Excel, Word, and Outlook; experience with reporting and data analysis tools is preferred.

• Strong attention to detail and organizational skills, with the ability to maintain accurate audit documentation and records.

• Ability to manage multiple assignments, prioritize workload, and meet deadlines in a fast-paced environment.

• Strong written and verbal communication skills, including the ability to deliver constructive, guideline-based feedback to providers and coders.

• Ability to work independently within established procedures while collaborating effectively with a team.

• Demonstrated problem-solving skills and a proactive, solutions-oriented approach.

Benefits:

• Annual salary range of $80,000–$100,000 USD.

• Health insurance.

• Dental and vision coverage.

• Employee assistance plan.

• Paid family leave.

• Short-term disability and life insurance.

• 401(k) retirement plan with employer match.

• Flexible spending accounts.

• Employee discount program.

• Employee referral program.