Coding Auditor

Hybrid position based in Baltimore, MD requiring 1-2 days in office per week.

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.
• Perform other duties as assigned.

Requirements

• 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
• Auditing
• CCS
• CPC
• Education
• Physician

Pay

The pay range for this position is $66,102 - $92,560 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

UMMS offers a comprehensive benefits package including health coverage, retirement plans, wellness programs, paid leave, tuition remission, and employee discounts to support both professional and personal well-being.

• Health and Insurance Benefits: Medical, dental, and vision coverage for eligible employees and their dependents, with enrollment effective from the first day of employment if completed within 31 days. Prescription drug benefits are managed through MedImpact. Employees can also access life insurance, long-term disability, and accidental death & dismemberment (AD&D) coverage. Flexible Spending Accounts (FSAs) allow pre-tax savings on qualified medical and dependent care expenses.
• Retirement and Financial Planning: Employees can participate in mandatory and supplemental retirement plans. UMMS provides resources for retirement planning and encourages additional savings options.
• Leave and Work-Life Balance: Generous leave package, including sick leave, personal leave, holidays, and Family Medical Leave.
• Wellness and Support Programs: Programs like Launch Your Life support health, wellness, and personal growth. Employees can access emotional, financial, and personal support services, as well as participate in wellness activities tailored to their goals.
• Professional Development and Tuition Remission: Tuition remission programs allow employees to take classes at University System of Maryland institutions tuition-free.
• Employee Discounts and Perks: Access to exclusive discounts on products and services through the UMMS Beneplace platform.

Schedule

This is a permanent, hybrid position based in Baltimore, MD.