Coding Education, Quality Auditor
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Job Description
Coding Education & Quality Auditor ensuring surgical coding accuracy for nimble solutions. Performing audits and educating coders while contributing to quality improvement initiatives.
Responsibilities:
- Perform prospective and retrospective audits of outpatient and professional surgical coding, including CPT, ICD-10-CM, modifier assignment, and compliance with Official Coding Guidelines, NCCI/OCE edits, and payer policies
- Support and maintain the coding quality assurance program, including audit methodologies, scoring, documentation standards, and quality tracking processes
- Analyze audit results and quality trends to identify risk areas, educational needs, and opportunities for process improvement
- Develop and deliver targeted coder- and provider-facing education, including remediation, training sessions, and client-specific education as needed
- Prepare client-facing audit summaries and reports that communicate quality scores, trends, and recommended actions clearly and professionally
- Collaborate with Coding Operations and cross-functional teams to support workflow optimization, standardization of best practices, and achievement of quality and service-level expectations
- Provide expert-level support for complex coding questions across Ambulatory Surgery Centers and Professional Fee services
- Participate in quality and compliance initiatives, including follow-up audits, monitoring of corrective actions, and validation of improvement outcomes
- Contribute to special projects related to audits, quality improvement, workflow enhancements, client onboarding, and ongoing client support.
Requirements:
- 8–10+ years of coding experience, including outpatient and/or professional surgical coding
- 5+ years of coding quality auditing and/or coding education experience
- Advanced knowledge of CPT, ICD-10-CM, modifier usage, Medicare regulations, OPPS, and payer policies
- Experience with surgical specialties such as orthopedics, spine, pain management, ophthalmology, and general surgery
- Strong written and verbal communication skills, including client-facing education and presentation capabilities
- Excellent analytical skills with the ability to interpret audit data and translate findings into actionable education
- Highly organized with the ability to manage multiple priorities and meet deadlines in a fast-paced, remote environment
- Self-directed, solution-oriented mindset with strong critical thinking and problem-solving abilities.
- Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint.
Benefits:
- Professional development opportunities
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