RCS Medical Coding Auditor (CPC, CPMA)

Position Summary

The 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.

Key Responsibilities

• Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback

• Validate 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 guidelines

• Conduct medical chart audits of professional services across multiple specialties

• Identify coding discrepancies, compliance risks, trends, root causes, and documentation gaps

• Support coding education through feedback, targeted training, and reference materials

• Prepare clear, defensible audit documentation including rationale and references

• Provide actionable recommendations to address audit findings and reduce future risk

• Track audit outcomes and trends to support leadership reporting and risk mitigation strategies

• Support denial prevention, resolution and appeal strategies

• Collaborate across teams to assist with coding support

Required Qualifications

• CPC (Required) and CPMA (Required/In Process)

• 2+ years of ProFee auditing experience

• Knowledge of:

  • E/M documentation guidelines
  • Modifier rules and NCCI edits
  • CPT, ICD-10-CM, HCPCS Level II

• High attention to detail with strong analytical and critical-thinking skills

• Excellent written and verbal communication skills for audit reporting and education

• Proficiency with EHRs, coding and auditing tools

• Proficiency with Microsoft Office Suite

Preferred Qualifications

• Multi-specialty coding and auditing experience with preferred background in E/M Coding, Orthopedics, Pain Management, Urology

• Background in coding quality programs or compliance teams

• Advanced reporting skills for audit tracking and trend analysis

• Prior consulting or client-facing audit experience

Compensation

Compensation Range: $57,728 - $80,243

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget.