Medical Coding Auditor Job Description [Updated for 2025]

In the healthcare industry, the role of a medical coding auditor is becoming increasingly critical.

As healthcare systems become more complex, the demand for skilled professionals who can ensure accuracy and compliance in medical coding continues to grow.

But what exactly does a medical coding auditor do?

Whether you are:

• A job seeker looking to understand the intricacies of this role,
• A hiring manager aiming to outline the perfect candidate,
• Or simply curious about the responsibilities and tasks of a medical coding auditor,

You have come to the right place.

Today, we present a customizable medical coding auditor job description template, designed for effortless posting on job boards or career sites.

Let’s dive right in.

Medical Coding Auditor Duties and Responsibilities

Medical Coding Auditors play a vital role in the healthcare industry by ensuring that medical coding within a health organization is done accurately and is compliant with federal regulations and insurance guidelines.

Their daily duties and responsibilities include:

• Review and verify the accuracy of medical records, codes and billing data
• Conduct audits to ensure correct coding of diagnostic procedures
• Investigate any discrepancies or inconsistencies in medical documentation and coding
• Train and provide feedback to medical coders and practitioners on correct coding practices
• Keep up-to-date with current medical coding guidelines and regulations
• Assist in the development and implementation of coding policies and procedures
• Prepare and present reports on audit results and recommendations for improvement
• Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) and other relevant laws

 

Medical Coding Auditor Job Description Template

Job Brief

We are looking for a meticulous and detail-oriented Medical Coding Auditor to join our team.

The Medical Coding Auditor will be responsible for conducting internal audits of medical coding and billing activities to ensure compliance with regulatory standards and guidelines.

The responsibilities include reviewing and validating medical documents, identifying and correcting coding errors, and implementing corrective action plans.

The successful candidate should have a strong understanding of medical terminology, clinical coding systems, and relevant healthcare regulations.

The ultimate goal of the role is to ensure that our medical billing operations are accurate and in compliance with all regulatory requirements.

 

Responsibilities

• Perform audits on medical coding to ensure accuracy and compliance with guidelines and regulations.
• Review medical documents to validate diagnoses, procedures, and treatment codes.
• Identify and correct coding errors and discrepancies.
• Prepare reports on audit findings, and present recommendations for improvements.
• Collaborate with medical coders and billing staff to implement corrective action plans.
• Stay current with changes in medical coding and billing regulations and guidelines.
• Provide training and education to staff on coding and billing compliance issues.
• Monitor the effectiveness of corrective actions and improvement initiatives.
• Participate in regulatory audits and inspections.

 

Qualifications

• Proven experience as a Medical Coding Auditor or similar role in healthcare.
• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is required.
• Excellent knowledge of medical coding guidelines and regulations, including ICD-10, CPT, and HCPCS.
• Ability to review and analyze clinical records and medical reports.
• Strong analytical and problem-solving skills.
• Excellent communication and presentation skills.
• Proficiency in MS Office and coding software.
• Attention to detail and accuracy.
• Associate’s or Bachelor’s degree in Health Information Management or related field is preferred.

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Medical Coding Auditor
• Work Environment: Office setting with occasional travel for audits or inspections.
• Reporting Structure: Reports to the Coding Compliance Manager or Director of Coding.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $65,000 minimum to $85,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Medical Coding Auditor Do?

Medical Coding Auditors typically work in hospitals, clinics, or other healthcare facilities.

They can also work for insurance companies, or as independent consultants.

Their main role is to review and audit medical coding information for adherence to company policy, industry standards, and federal regulations.

They examine medical documents, patient records, and billing information to ensure accuracy.

Medical Coding Auditors validate the appropriateness of diagnosis, procedure and modifier codes used by medical coders.

They also check the accuracy of medical documentation, the correct application of coding guidelines, and the appropriateness of provided services.

They often collaborate with medical billing teams, medical coders, and healthcare providers to provide feedback and education on correct coding practices and compliance issues.

As part of their role, they may also be tasked with developing, initiating, and maintaining effective and efficient communication with stakeholders on matters such as coding guidelines, billing procedures, and regulatory changes.

They are responsible for ensuring that all codes are current, accurate, and documented appropriately to support the level of service rendered to patients.

Finally, they may also assist in claim disputes, provide advice on coding standards, and contribute to the development of coding policies and procedures.

 

Medical Coding Auditor Qualifications and Skills

A Medical Coding Auditor should possess certain skills and qualifications to conduct audits on medical coding and billing, these include:

• Detailed knowledge of medical codes, coding guidelines, and regulatory requirements to ensure compliance.
• Experience in medical billing and coding processes, including knowledge of ICD-10, CPT, and HCPCS codes.
• Excellent analytical and problem-solving skills to identify discrepancies or inconsistencies in medical coding and billing.
• Strong communication skills to convey audit findings clearly and concisely to healthcare professionals and management.
• Time management skills to complete audits in a timely manner and meet deadlines.
• Ability to work independently and make informed decisions based on thorough analysis and research.
• Computer proficiency and adept at using medical billing software and electronic health records.
• Continuous learning and adaptability to stay updated with changes in healthcare regulations and coding guidelines.
• Attention to detail and accuracy to ensure correct coding and billing practices.

 

Medical Coding Auditor Experience Requirements

For the role of Medical Coding Auditor, candidates typically need several years of experience in the medical coding field.

A minimum of 3-5 years in medical coding or a related healthcare field is often required.

In their previous roles, they should have gained substantial experience in reviewing and auditing medical coding data, as well as identifying and correcting coding errors.

This experience could be gained from working in roles such as Medical Coder, Coding Specialist, or Health Information Technician.

Familiarity with various coding systems, such as International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS), is essential for this role.

Some Medical Coding Auditor roles may require candidates to have prior experience in a supervisory or lead role, particularly if the role involves managing a team or conducting training sessions.

In addition, candidates may also require certification from organizations such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).

Such certifications often require a certain amount of professional coding experience, in addition to passing an examination.

As the field of medical coding is constantly evolving, it is also beneficial for candidates to demonstrate ongoing learning and development through further education and professional development courses.

 

Medical Coding Auditor Education and Training Requirements

Medical Coding Auditors typically have an associate’s degree or certificate in Health Information Technology, Medical Coding, Medical Billing, or a related field.

This program trains students in areas such as anatomy, physiology, medical terminology, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, healthcare statistics, and computer systems.

In addition to the degree, they need to have a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification through the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).

Some roles may prefer or require candidates with a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification.

This requires additional education and examination.

Medical Coding Auditors must have a comprehensive understanding of medical terminology, disease processes, and pharmacology.

They should also be familiar with different types of insurance plans, regulations, compliance, and the healthcare industry’s various coding systems.

Experienced professionals may pursue a Certified Professional Medical Auditor (CPMA) credential to validate their expertise in medical auditing.

Continuing education is crucial in this role, as healthcare regulations and codes often change.

Therefore, ongoing training and recertification are often necessary to stay updated in this field.

Prior experience in medical coding and auditing is often a prerequisite for this role, with many employers requiring at least two years of experience in a related healthcare setting.

 

Medical Coding Auditor Salary Expectations

A Medical Coding Auditor can expect to earn an average salary of $65,000 (USD) per year.

However, the actual salary can vary depending on factors such as the individual’s level of experience, the location of the job, and the size and type of the employing organization.

 

Medical Coding Auditor Job Description FAQs

What skills does a Medical Coding Auditor need?

Medical Coding Auditors should have strong analytical skills to accurately interpret medical record data.

They must possess extensive knowledge of medical terminology, coding guidelines, disease processes, and pharmacology.

Good communication skills are also essential to convey their findings effectively to medical coders and healthcare professionals.

 

Do Medical Coding Auditors need a degree?

Yes, Medical Coding Auditors typically need a bachelor’s degree in health information management or a related field.

They should also have professional coding certification such as Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).

Some employers might prefer candidates with a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification.

 

What should you look for in a Medical Coding Auditor’s resume?

Check for a relevant degree and coding certifications.

Look for experience in medical coding and auditing in various healthcare settings.

Knowledge of ICD-10-CM, CPT, and HCPCS Level II coding standards is crucial.

Familiarity with electronic health records (EHR) and coding software is also important.

Additional skills like attention to detail, strong communication, and data analysis abilities should also be noted.

 

What qualities make a good Medical Coding Auditor?

A good Medical Coding Auditor is methodical, detail-oriented, and has a high degree of accuracy in their work.

They are excellent problem solvers who can interpret complex medical records.

Strong ethical standards are crucial as they deal with sensitive patient information.

They should also be able to communicate effectively with diverse healthcare professionals.

 

Is it difficult to hire Medical Coding Auditors?

Hiring Medical Coding Auditors can be challenging due to the specialized nature of the role.

It requires candidates with a specific skill set and a solid understanding of medical coding and auditing principles.

Additionally, the candidate must be up-to-date with changing healthcare regulations and coding standards.

Hence, finding the right fit might take time and effort.

 

Conclusion

And there you have it.

Today, we uncovered the true essence of being a medical coding auditor.

Guess what?

It’s not just about reviewing medical records.

It’s about ensuring accurate patient care and healthcare services, one medical code at a time.

With our comprehensive medical coding auditor job description template and real-world examples, you’re ready to take the next step.

But why limit yourself?

Dive deeper with our job description generator. It’s your ultimate tool for creating precise job listings or tailoring your resume to perfection.

Remember:

Every medical code reviewed contributes to the larger healthcare system.

Let’s enhance the world of healthcare. Together.

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