Job Description

Job Summary
We are seeking an experienced Medical Coding Auditor (CPMA) to join our healthcare compliance team. The ideal candidate will be responsible for conducting coding audits, ensuring adherence to regulatory guidelines, identifying compliance risks, and providing recommendations for process improvements. This role demands strong expertise in auditing, deep knowledge of medical coding standards, and the ability to guide coding teams toward accuracy and compliance. Key Responsibilities
Perform internal and external audits of coded medical records to ensure compliance with CMS, OIG, and payer guidelines.
Review documentation for accuracy and completeness, ensuring ICD-10-CM, CPT, and HCPCS coding compliance.
Identify coding errors, trends, and risks; prepare audit reports with recommendations.
Collaborate with coding teams to provide education, training, and corrective action plans.
Assist in developing policies and procedures for coding compliance and audit processes.
Partner with physicians, compliance officers, and billing teams to improve documentation and minimize audit risks.
Stay updated with evolving federal regulations, payer policies, and coding guidelines. Required Skills & Qualifications
Certification: CPMA is mandatory. Additional certifications like CPC, CCS, or COC are highly preferred.
Strong expertise in ICD-10-CM, CPT, HCPCS, and medical terminology.
8+ years of experience in medical coding, with a minimum of 3 years in auditing/compliance.
Proven ability to conduct detailed audits and prepare actionable reports.
Excellent knowledge of healthcare laws, payer regulations, and audit procedures.
Strong analytical, problem-solving, and communication skills.
Proficiency with coding/audit software and MS Office tools.

Skills Required