Job Description

Under the guidance of A/R and Billing Manager, the Coding Auditor reviews and evaluates medical records to ensure accuracy of patient records and billing as well as compliance with coding procedures and standards, based on Sunset Health’s protocols, regulatory requirements (CMS, Medicare, Medicaid, etc.), and American Medical Association (AMA). Coding Auditor inspects medical coding documents for errors, corrects mistakes, reports repeated errors to management, conducts inquiries into departments that output a significant number of coding mistakes, provides processing recommendations, validates claims determinations, and provides training and education to providers, medical billers, and coders. Additionally, Coding Auditors supports management with other auditing procedures as needed, ensures compliance with fee-schedule, and works closely with AR & Billing Manager to improve department efficiencies, make recommendations that will support the departmental goals.  

Skills / Requirements

  • Must be able to obtain a fingerprint clearance card. If not already obtained, Fingerprint Clearance card application must be submitted within 5 business days of employment.
  • Must be able to successfully pass a background check and a health and drug screen.
  • Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) required.
  • Associate degree preferred.
  • A minimum of five years of experience in claims adjudication, medical record auditing or medical billing is required.
  • Extensive knowledge of ICD-9, ICD10, LOINC, and CPT codes, Medicare and Medicaid compliance requirements and auditing procedures required.