Job Summary

The E/M Auditor reviews medical records across various settings-including hospitals, clinics, and emergency departments-to validate the level of service billed. They serve as a bridge between the coding team and healthcare providers, identifying documentation gaps and providing data-driven education to improve coding accuracy.

Core Responsibilities

Audit Performance (Inpatient Outpatient)

- IP Focus: Audit hospital admissions, daily progress notes, and discharge services. Validate that the complexity of the patient's condition justifies the level of care in an acute setting.

- OP Focus: Audit office visits and Emergency Department (ED) visits, ensuring code selection aligns with the 2021/2023 MDM or Time-based rules.

- Pre-billing Post-billing Audits: Conduct 'shadow audits' before claims are submitted (pre-bill) to prevent denials, and retrospective audits (post-bill) to assess long-term compliance.

- MDM Time Validation: Scrutinize the 'Amount and Complexity of Data Reviewed,' 'Number and Complexity of Problems Addressed,' and 'Risk' to ensure the MDM table is applied correctly.

Provider Education Feedback

- Documentation Improvement: Identify 'cloning' (copy-pasting), lack of specificity in the plan of care, or insufficient time documentation.

- One-on-One Education: Meet with physicians and Mid-Level Providers (PAs/NPs) to explain audit findings and provide corrective guidance.

- Reporting: Create detailed audit spreadsheets and executive summaries showing accuracy rates, financial impact, and trend analysis.

Compliance Regulation

- Guideline Mastery:



Stay current with CMS, AMA, and OIG updates.

- Edit Review: Check for National Correct Coding Initiative (NCCI) edits and ensure appropriate use of modifiers (e.g., Modifier 25 or 57).

Required Qualifications & Skills

Technical Skills

- Code Sets: Mastery of ICD-10-CM, CPT, and HCPCS Level II.

- Guidelines: Expert knowledge of the 1995/1997 E/M guidelines (where still applicable) and the 2021/2023/2024 E/M updates.

- Software: Proficiency in Electronic Health Records (EHR) like Epic, Cerner, or Meditech, and auditing software (e.g., 3M, RevPoint).

Education & Experience

- Education: Any graduation from medical coding.

- Experience: Usually 3-5+ years of active E/M coding experience, with at least 1-2 years specifically in an auditing or quality review capacity.

Mandatory Certifications

- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist - Physician-based).

- CPMA (Certified Qualified Medical Auditor) - Highly preferred or required within 6 months of hire.

- Optional: CIC (Certified Inpatient Coder) or CCS for facility-side auditing.

Key Performance Indicators (KPIs)

- Accuracy Rate: Maintaining a minimum 95% accuracy rate for audited charts.

- Audit Volume: Meeting weekly/monthly quotas (e.g., auditing 30-50 charts per week).

- Denial Reduction: Measurable

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 QA - HIM Services (Noida)
🏢 CorroHealth
📍 Noida