Facility Outpatient Auditor - ED, SDS, OBS, I&I

Accountabilities

Conduct outpatient coding audits: Perform complex retrospective reviews of medical records to identify coding and billing errors, inconsistencies, documentation gaps, and compliance risks across ED, SDS, OBS, and I&I services.
Validate coding accuracy and reimbursement: Conduct second-level reviews of diagnosis codes, procedure codes, and billing practices to ensure compliance with applicable coding standards, regulatory requirements, and reimbursement policies.
Apply official coding guidelines: Interpret and apply guidance from the American Hospital Association (AHA), Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), Coding Clinic, CPT Assistant, and other relevant authoritative sources.
Analyze audit findings: Investigate coding discrepancies, identify root causes, recognize recurring quality issues, and recommend corrective actions to prevent errors from recurring.
Support compliance and denial resolution: Research and respond to inquiries concerning coding compliance, inappropriate coding, claim denials, billable services, medical necessity, and third-party payer requirements.
Provide technical guidance and training: Educate coding staff on documentation standards, coding guidelines, regulatory changes, reimbursement methodologies, and compliance requirements.
Identify documentation improvement opportunities: Recognize when physician queries may be necessary based on clinical information, documentation gaps, and accurate code assignment requirements.
Monitor coding quality and productivity: Track coder performance, review ongoing quality results, identify areas requiring improvement, and help maintain a minimum overall coder accuracy rate of 95%.
Maintain quality assurance standards: Keep quality review percentages as close as possible to the internal target of 10%, while ensuring appropriate monitoring and timely resolution of coding issues.
Develop reports and deliverables: Prepare monthly reports, audit findings, coder feedback, status updates, and other required documentation for management and operational stakeholders.
Improve coding workflows: Contribute to the design and enhancement of systems, processes, and tools that improve coding accuracy, productivity, and operational efficiency.
Maintain professional standards: Keep coding credentials current and remain informed about changes in coding practices, reimbursement methodologies, regulatory requirements, and compliance expectations.
Protect confidential information: Safeguard patient health information and client data, following applicable privacy and security regulations, ethical coding standards, and internal compliance policies.
Collaborate across teams: Communicate respectfully with colleagues, participate in training sessions and corporate meetings, share knowledge, and coordinate work schedules and activities with management.
Deliver reliable results: Complete assignments accurately and on time, maintain clear communication regarding work progress, and proactively address issues that could affect coding quality or service delivery.
Requirements
Professional experience: At least two years, preferably three or more, of coding and/or auditing experience in inpatient and outpatient hospital or facility settings.
Coding certification: An active, recognized coding credential from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) is required. Preferred credentials include CPC, COC, or CCS; RHIT and RHIA credentials may also be considered.
Outpatient facility expertise: Demonstrated experience with facility inpatient/outpatient auditing and coding, particularly in emergency department, same-day surgery, observation, and infusion and injection settings.
Hospital billing knowledge: Familiarity with hospital outpatient billing processes, Ambulatory Payment Classification (APC) assignment, reimbursement methodologies, and the relationship between clinical documentation and code assignment.
Regulatory and compliance knowledge: Ability to interpret official coding guidelines, payer requirements, medical necessity criteria, documentation standards, and applicable privacy and compliance regulations.
Quality assurance experience: Strong ability to review coding work, identify errors, evaluate root causes, monitor quality metrics, and recommend corrective actions that improve accuracy and consistency.
Electronic medical records proficiency: Experience working with electronic medical record (EMR) systems is strongly preferred, including the ability to navigate multiple systems and review handwritten medical records.
Technical proficiency: Working knowledge of Microsoft Office applications, particularly Word and Excel, with the ability to prepare reports, analyze findings, and document audit results.
Analytical skills: Excellent attention to detail, critical thinking, and problem-solving abilities, with the capacity to evaluate complex medical records and identify discrepancies accurately.
Communication skills: Strong written and verbal communication skills, including the ability to explain coding decisions, provide constructive feedback, and communicate technical information clearly.
Training and coaching abilities: Capacity to support coding staff through technical guidance, knowledge sharing, and feedback that promotes continuous improvement.
Organization and time management: Ability to prioritize multiple assignments, meet deadlines, maintain accurate records, and consistently deliver high-quality work.
Independent work and teamwork: Ability to work with minimal supervision while collaborating effectively with colleagues and supporting multiple clients and projects.
Customer service orientation: At least one year of customer service support experience, with a commitment to responsiveness, professionalism, and client satisfaction.
Adaptability and initiative: Demonstrated resourcefulness, initiative, and flexibility when navigating different client requirements, medical record systems, and changing priorities.
Remote work readiness: Ability to work effectively in a remote environment, maintain predictable attendance, communicate proactively, and remain productive while managing competing deadlines.
Benefits
Remote work flexibility: Full-time remote position for candidates residing in the United States.
Professional development: Opportunities to maintain and expand coding expertise through ongoing education, training, and exposure to evolving reimbursement and compliance requirements.
Career growth: Opportunities to strengthen auditing, quality assurance, and healthcare revenue cycle expertise.
Collaborative environment: Work with coding professionals and operational teams committed to accuracy, compliance, and continuous improvement.
Meaningful impact: Help improve hospital outpatient coding quality, reduce billing errors, support appropriate reimbursement, and strengthen healthcare financial operations.
Continuous learning: Participate in professional training, team meetings, and knowledge-sharing initiatives that support technical development.