Job highlights

- CCS (Certified Coding Specialist) - Required for Inpatient / Facility. . CPC or CCS-P - Required for Professional / E/M. . CPMA (Certified Professional Medical Auditor) - Mandatory for most high-level auditor roles. .

Education: Bachelors or Associates degree in Life Sciences

EM/IP/OP Medical Coding Auditor

Job Summary

The Medical Coding Auditor (E/M, IP, OP) is responsible for performing comprehensive quality reviews of medical records to ensure that all documented services are captured accurately and in compliance with official guidelines. This role balances the clinical complexity of the procedures with the regulatory nuances of E/M leveling. The auditor identifies areas of risk, provides educational feedback to coders and clinicians, and ensures the organization is prepared for external audits.

Key Responsibilities

1. E/M (Evaluation Management) Auditing

- Leveling Validation: Audit professional and facility E/M codes based on CMS/AMA guidelines, focusing on Medical Decision Making (MDM) or Time.

- Specialty E/M: Review complex E/M services including Critical Care, Observation, and Consultations.

- Modifier Accuracy: Ensure proper use of modifiers (e.g., -25, -57, -24) to prevent denials for bundled services.

2. Inpatient (IP) Auditing

- DRG Validation: Validate the Principal Diagnosis and the impact of CC/MCCs on the MS-DRG or APR-DRG assignment.

- ICD-10-PCS Review: Audit complex inpatient procedure codes (PCS) to ensure the correct root operation and approach were selected.

- Clinical Validation: Verify that high-acuity diagnoses (e.g., Malnutrition, Encephalopathy, Acute Kidney Injury) are clinically supported by the medical record.

3. Outpatient (OP) Auditing

- CPT/HCPCS Validation: Review outpatient surgery (ASC), Emergency Department, and clinic visits for accurate CPT/HCPCS code selection.

- APC OCE Edits:



Ensure claims comply with the Outpatient Prospective Payment System (OPPS) and pass Outpatient Code Editor (OCE) and NCCI edits.

- Medical Necessity: Verify that ICD-10-CM codes support the medical necessity of the procedures performed (LCD/NCD compliance).

4.

Quality Reporting

Education

- Reporting: Generate detailed audit reports identifying accuracy rates, financial impact, and "missed opportunities."

- Education: Lead 1-on-1 or group training sessions for coders and physicians to correct systemic errors.

- Query Oversight: Audit the physician query process to ensure queries are compliant and clinically appropriate.

Qualifications Requirements

- Experience: 5-7 years of multi-specialty coding experience, with at least 3 years specifically in a formal auditing role covering E/M, IP, and OP.

- Certifications (Dual-Certification highly preferred):

- CCS (Certified Coding Specialist) - Required for Inpatient/Facility.

- CPC or CCS-P - Required for Professional/E/M.

- CPMA (Certified Qualified Medical Auditor) - Mandatory for most high-level auditor roles.

- Education: Bachelor's or Associate's degree in Life Sciences.

Technical Skills

- E/M Mastery: Expert knowledge of the 1995/1997 (where applicable) and the current 2021/2023 E/M guidelines.

- PCS Logic: Deep understanding of the 7-character ICD-10-PCS code structure.

- Regulatory Knowledge: Expert-level understanding of NCCI edits, MUEs, OIG Work Plans, and CMS IOMs.

- Software Proficiency:

- Encoders: 3M 360 (Encompass), Optum.

- EHRs: Epic (ASAP, Stork, Radiant, OpTime), Cerner, or Allscripts.

- Audit Tools: MDaudit, RevPoint, or similar platforms.

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 (Hyderabad)
🏢 CorroHealth
📍 Hyderabad