Medical Audit Specialist

Position Overview

Apex Skin is a physician-led and rapidly growing dermatology practice committed to delivering exceptional patient experiences. We are seeking a skilled and motivated Medical Audit Specialist. The Medical Audit Specialist is responsible for reviewing medical records, billing data, and coding documentation to ensure accuracy, compliance with federal and state regulations, and adherence to organizational policies. This role involves conducting random and focused coding audits, documenting findings, preparing and presenting results, and performing investigations to provide comprehensive feedback.

As a subject matter expert in coding, the Medical Audit Specialist offers guidance and support to maintain compliance with coding standards, regulatory requirements, and best practices. The position is critical for preserving the integrity of healthcare billing and coding, preventing errors, and supporting proper reimbursement processes.

Schedule

• Full-time, Monday through Friday [40 hours per week]
• This position is primarily remote; however, candidates must be flexible to attend in-office meetings and travel to Apex Skin locations as needed to support business objectives.

Essential Functions

• Conduct regular and focused audits of medical coding and billing records to assess accuracy and completeness.
• Review clinical documentation (e.g., notes, diagnostic reports, treatment plans, medication orders) for accuracy and compliance.
• Identify and correct coding errors, discrepancies, and potential compliance issues.
• Ensure coding practices comply with HIPAA, CMS, OIG, and payer-specific guidelines.
• Prepare detailed audit reports and present findings with recommendations for improvement.
• Provide feedback, education, and training to healthcare providers and coding staff on proper coding techniques and areas for improvement.
• Collaborate with providers, coding specialists, and compliance teams to resolve documentation or coding issues.
• Respond to coding questions and provide official coding references and guidelines.
• Oversee the quarterly PA Supervision chart review process.
• Act as the primary contact for RAC audits and related requirements.
• Assist in developing and updating coding policies, procedures, and programs to improve accuracy and compliance.
• Analyze coded data, case mix reports, and statistical reports to identify risks and recommend documentation improvements.
• Support risk assessments, compliance and quality initiatives, and facilitate scheduled external audits.
• Maintain current knowledge of coding principles, standards, healthcare regulations, and payer requirements.
• Monitor industry trends and regulatory changes for potential organizational impact.
• Report compliance and risk issues to the compliance department and recommend process improvements.
• Manage other internal compliance audit tasks assigned.

Qualifications

• Associate’s degree required in Health Information Management or Healthcare Administration; Bachelor’s preferred. Equivalent experience may be considered.
• Minimum 5 years of medical coding experience required; 2 or more years auditing experience preferred.
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required
• CPMA (Certified Professional Medical Auditor) or CHIAP (Certified Healthcare Internal Audit Professional) preferred and highly desirable.
• Strong knowledge of ICD-10, CPT, HCPCS coding systems.
• Proficiency with EHR systems and audit tools.
• Excellent analytical, communication, and problem-solving skills.
• Ability to manage multiple priorities and meet deadlines.
• High level of integrity and confidentiality.

Career Growth Opportunities

Motivated Medical Audit Specialist may pursue:

• Cross-training in related departments
• Potential transition into Compliance or Revenue Cycle Management leadership, or coding/compliance education/training role
• Apex Skin provides training, mentoring, and development opportunities for individuals who demonstrate skill, reliability, compassion, and clinical accuracy.

Physical Requirements & Work Environment

• Work performed in a remote home office environment with reliable internet connectivity.
• Prolonged periods of sitting and computer use for data entry, coding review, and electronic communication.
• Frequent use of hands and fingers for typing and navigating multiple software systems.
• Ability to communicate clearly via phone, email, and virtual platforms with providers and team members.
• Visual acuity sufficient to read electronic medical records, coding guidelines, and payer documentation.
• Requires consistent attention to detail and ability to maintain focus in a virtual setting.
• Must adhere to HIPAA and Apex Skin privacy standards while working remotely.

Apex Skin Culture

Apex Skin fosters a collaborative, patient-first environment built on compassion, clinical excellence, and teamwork. We believe in a respectful and supportive workplace where employees feel valued, trusted, and empowered to contribute to exceptional patient experiences and meaningful clinical care.

Employee Health & Safety Requirements:

All patient-facing employees are required to provide proof of a TB test within the past 12 months and an annual flu vaccination as part of Apex Skin’s employee health and safety protocols. The Hepatitis B vaccination series is also strongly recommended for clinical staff due to potential occupational exposure risks. Apex Skin complies with federal and Ohio law by providing reasonable accommodations for medical conditions or sincerely held religious beliefs that prevent vaccination. Employees seeking an accommodation should contact Human Resources for more information.

Equal Employment Opportunity Statement:

Apex Skin provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Apex complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.