Lead - Healthcare - Coding Quality Auditor

About this role

The Medical Coding Auditor is responsible for keeping Sutherland coders in compliance by reviewing medical records and coding practices to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in compliance with federal, state, payer, and organizational guidelines. This role evaluates coding accuracy, identifies documentation deficiencies, conducts audits, provides education to coding staff and providers, and supports revenue cycle integrity while minimizing compliance risk.

Essential Duties and Responsibilities Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and/or specialty services. Review medical documentation to validate the accuracy and completeness of assigned diagnosis and procedure codes. Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines. Identify coding errors, documentation gaps, and reimbursement opportunities.

Prepare detailed audit reports outlining findings, trends, recommendations, and corrective actions. Provide one-on-one and group education to coders, providers, and clinical staff regarding coding updates, documentation improvement, and compliance requirements. Monitor coding quality metrics and develop action plans to improve coding accuracy and consistency. Stay current on coding regulations, Official Coding Guidelines, CMS regulations, payer policies, and industry best practices.

Assist with internal and external audits, payer reviews, and regulatory investigations. Maintain confidentiality of protected health information (PHI) in accordance with HIPAA regulations. Participate in policy development, process improvement initiatives, and coding education programs. Track audit results and identify recurring trends to support continuous quality improvement. Qualifications Minimum of 3-5 years of medical coding experience in a healthcare setting.

Minimum of 2 years of coding audit or quality review experience preferred. Current coding certification such as: Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Coding Specialist (CCS) Certified Inpatient Coder (CIC) Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems.