For companies:
For professionals:
For everyone:
For developers:
Responsibilities
Position SummaryThe RCS Medical Coding Auditor is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback.The ideal candidate brings strong hands-on experience with professional fee coding, deep knowledge of E/M, surgical, and modifier use, and the ability to translate audit findings into actionable insights.Key ResponsibilitiesPerform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedbackValidate ICD‑10‑CM, CPT®, HCPCS, and modifier assignment against clinical documentation to ensure accuracy and compliance with AMA CPT, ICD-10, CMS, NCCI, and payer-specific guidelinesConduct medical chart audits of professional services across multiple specialtiesIdentify coding discrepancies, compliance risks, trends, root causes, and documentation gapsSupport coding education through feedback, targeted training, and reference materialsPrepare clear, defensible audit documentation including rationale and referencesProvide actionable recommendations to address audit findings and reduce future riskTrack audit outcomes and trends to support leadership reporting and risk mitigation strategiesSupport denial prevention, resolution and appeal strategiesCollaborate across teams to assist with coding supportMaintain confidentiality and comply with HIPAA and organizational policiesRequired QualificationsCPC (Required) and CPMA (Required/In Process)2+ years of ProFee auditing experienceKnowledge of:E/M documentation guidelinesModifier rules and NCCI editsCPT, ICD‑10‑CM, HCPCS Level IIHigh attention to detail with strong analytical and critical‑thinking skillsExcellent written and verbal communication skills for audit reporting and educationProficiency with EHRs, coding and auditing toolsProficiency with Microsoft Office SuitePreferred QualificationsMulti-specialty coding and auditing experience with preferred background in E/M Coding, Orthopedics, Pain Management, UrologyBackground in coding quality programs or compliance teamsAdvanced reporting skills for audit tracking and trend analysisPrior consulting or client‑facing audit experienceCompensation Range:$57,728-$80,243Enhancing Lives and Building CareersVeradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network.Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.
This job post is closed.