Coding Auditor (100% Work from Home)

Position Summary The Coding Audit and Support Specialist performs independent coding audits that validate the accuracy, completeness, compliance, and defensibility of coding outcomes. This role supports Revenue Integrity’s assurance and risk oversight function by reviewing coded encounters, documenting findings with evidence and context, and surfacing defects or risk patterns early enough for accountable leaders to act. This is an individual contributor role within Revenue Integrity. The role executes assigned audits, maintains objective documentation, and escalates material risks, repeat defects, or unclear scenarios through defined channels. It does not perform coding work, correct encounters, deliver provider education, determine compliance policy, own corrective action, or manage customer outcomes.

Qualifications

Required

• Working knowledge of medical coding standards, including ICD-10-CM, CPT, and HCPCS.
• Understanding of coding accuracy, documentation requirements, audit standards, and compliance concepts.
• Ability to review coded encounters objectively and identify discrepancies, documentation gaps, risk indicators, and repeat defect patterns.
• Strong analytical judgment to distinguish isolated errors from material issues that require escalation.
• Clear written communication skills for documenting findings, supporting evidence, and audit rationale.
• Ability to manage assigned audit work independently while following defined methodology, scope, and escalation standards.
• Professional communication skills to clarify findings without assigning blame or assuming ownership of correction.

Preferred

• 2 or more years of medical coding, coding audit, revenue cycle, compliance, or healthcare quality review experience.
• Coding certification such as CPC, CCS, or equivalent.
• Experience in an FQHC, community health center, or other complex healthcare revenue cycle environment.
• Experience supporting formal audit, quality assurance, or risk review processes.

Key Responsibilities and Expected Performance Outcomes

Key Responsibilities

• Complete assigned coding audits according to approved methodology, review scope, sampling expectations, and due dates.
• Evaluate coded encounters for coding accuracy, documentation support, completeness, and alignment with coding standards and organizational requirements.
• Identify coding discrepancies, documentation gaps, repeat defects, potential compliance exposure, and revenue risk indicators during audit review.
• Document each finding with clear rationale, supporting evidence, applicable references, business context, and risk significance.
• Escalate material compliance risks, recurring coding defects, financial exposure, and ambiguous scenarios through defined escalation pathways.
• Analyze audit results to surface recurring trends, defect patterns, and systemic risk indicators for accountable leaders.
• Clarify audit findings for accountable leaders while maintaining role boundaries and avoiding ownership of correction, coding execution, provider education, or customer communication.
• Maintain audit objectivity, consistency, and professional rigor when findings are questioned, time-sensitive, or operationally complex.

Expected Performance Outcomes

• Assigned audits are completed by established due dates and follow approved methodology, scope, and documentation standards.
• Audit findings are evidence-based, internally consistent, and review-ready, with rationale and references sufficient for leadership review.
• Material compliance risks, repeat defects, and financial exposure indicators are escalated through the correct pathway with timely context and supporting evidence.
• Recurring coding issues and defect patterns are summarized clearly enough for accountable leaders to evaluate root cause, prevention, and next steps.
• Audit documentation enables informed decision-making without requiring rework due to unclear findings, missing support, or unsupported conclusions.
• Revenue Integrity audit work remains independent from coding execution, corrective action ownership, provider education, compliance policy decisions, and customer outcome accountability.

Core Competencies (Required for All Employees)

• Critical Thinking: Evaluates coding outcomes with sound judgment, distinguishes isolated errors from risk patterns, and determines when findings require escalation.
• Interpersonal Skills: Communicates findings clearly, professionally, and factually while maintaining a non-blaming audit posture.
• Organizing and Planning: Manages assigned audits, evidence, references, and documentation in a consistent, traceable, and timely manner.
• Production / Productivity: Completes audit work with steady throughput while maintaining accuracy, independence, and documentation quality.
• Dependability: Follows audit standards consistently, meets assigned timelines, and maintains defensible documentation even under operational pressure.