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.