Coding Auditor

About the role

Responsible for conducting independent physician coding and auditing reviews to ensure the accuracy, completeness, and compliance of medical record documentation supporting codes selected by providers and/or coders. This role ensures compliance with CMS guidelines, CPT, HCPCS, and ICD-10 code sets, while supporting providers through ongoing physician coding education, auditing feedback, compliance guidance, and training initiatives. This position plays a key role in physician documentation improvement, coding compliance, audit readiness, and provider education across the organization.

Responsibilities

• Conduct independent physician coding and auditing reviews to assess the adequacy of medical record documentation supporting codes selected by providers and/or coders.
• Perform detailed physician coding compliance audits to ensure adherence to CMS guidelines, CPT, HCPCS, ICD-10 code sets, and internal billing policies.
• Utilize MDaudit software to complete audit documentation, tracking, and reporting activities.
• Analyze provider, division, and departmental documentation and coding trends to identify compliance risks and recommend corrective actions.
• Support reporting of audit results, including trending, regulatory tracking, and responses to compliance inquiries.
• Develop and deliver physician coding education and training materials to improve documentation accuracy and coding compliance.
• Present physician coding audit findings and compliance risks to providers, leadership, and practice administrators.
• Create and administer targeted provider education and training programs to address documentation and coding gaps identified through auditing activities.
• Contribute to system-wide compliance education initiatives, including New Provider Education and Annual Compliance Training programs.
• Prepare reports for compliance leadership and executive stakeholders, highlighting key findings from physician coding and auditing activities.
• Conduct regulatory research and draft responses to coding and compliance inquiries.
• Monitor and communicate regulatory updates impacting physician coding, documentation, and billing compliance.
• Document and track compliance cases, investigations, and inquiries within the case management system.
• Support compliance investigations related to documentation, billing, and coding concerns.
• Assist in developing policies, standard operating procedures, audit tools, and education toolkits to strengthen physician coding and auditing practices.
• Meet departmental KPIs, including audit productivity, audit quality/accuracy, turnaround time, and provider education and training effectiveness.
• Maintain strong knowledge of CMS, CPT, HCPCS, ICD-10, and payer documentation requirements.

Qualifications

• High school diploma
• Five (5) years’ experience in coding including two (2) years of auditing/billing compliance experience.
• Certified Professional Coder (CPC) certification
• Experience in and working knowledge of Corporate Compliance.
• Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), or Certified Medical Auditor (CPMA) certification

Skills

• ProFee coding
• Coding
• Auditing
• CCS
• CPC
• Education
• Physician

Pay

The pay range for this position is $66,102.00 – $92,560.00 per year. Individual compensation offered within this range will depend on qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Benefits

• Health coverage (medical, dental, vision) for eligible employees and dependents
• Prescription drug benefits managed through MedImpact
• Life insurance, long-term disability, and accidental death & dismemberment (AD&D) coverage
• Flexible Spending Accounts (FSAs) for qualified medical and dependent care expenses
• Mandatory and supplemental retirement plans
• Sick leave, personal leave, holidays, and Family Medical Leave
• Wellness programs including Launch Your Life
• Emotional, financial, and personal support services
• Tuition remission for classes at University System of Maryland institutions
• Employee discounts via the UMMS Beneplace platform

Schedule

Hybrid position based in Baltimore, MD with 1–2 days in office per week.