What are the responsibilities and job description for the Medical Coding Auditor position at optimamedical?
About Optima Medical:
Optima Medical is an Arizona-based medical group consisting of 30 locations and over 130 medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities "Live Better, Live Longer" through personalized healthcare, with a focus on preventing the nation’s top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and deserving candidates aboard.
Optima is currently seeking a Medical Coding Auditor to join our team. This individual will be responsible for conducting detailed reviews of provider documentation to ensure accurate coding and compliance with CMS, payer guidelines, and internal policies. The Medical Coding Auditor will work closely with providers, coding staff, and the compliance team to identify documentation gaps, validate code accuracy, and deliver education that supports coding integrity and organizational performance.
Medical Coding Auditor Responsibilities:
- Conduct monthly audits of Evaluation & Management (E/M) services with a focus on Medical Decision Making (MDM) complexity, reviewing 25–30 encounters per day
- Validate CPT, ICD-10, and HCPCS codes against clinical documentation, ensuring codes accurately reflect services rendered and align with payer and regulatory guidelines
- Identify coding discrepancies including upcoding, under-coding, and unbundling across provider encounters
- Assess progress notes and supporting documentation — including labs, imaging, and referrals — to determine whether billed services and E/M levels are appropriately supported
- Apply accurate modifiers and coding conventions for varied encounter types, including shared visits, preventive care, and time-based billing
- Document audit findings using standardized formats, communicate results to providers and coding staff, and recommend corrective actions or highlight missed coding opportunities
- Provide ongoing education and feedback to improve documentation practices, support compliance initiatives, and maintain current knowledge of regulatory and coding updates
Medical Coding Auditor Qualifications:
- Minimum 4–5 years of experience in medical coding, with at least 2 years in a coding audit or compliance-focused role
- Certified Professional Coder (CPC) required; CPC-A and CCA not accepted — additional audit certification such as CPMA (Certified Professional Medical Auditor) strongly preferred
- Advanced knowledge of ICD-10-CM, CPT, and HCPCS, with demonstrated expertise in E/M coding and Medical Decision Making (MDM) complexity
- Thorough understanding of CMS guidelines, payer policies, and compliance standards including upcoding, under-coding, and unbundling
- Experience with EHR systems and audit tracking tools; eClinicalWorks (eCW) experience a plus — Microsoft Office proficiency (Outlook, Word, Excel) required
- Strong analytical and critical thinking skills with the ability to identify patterns and discrepancies across high volumes of documentation
- Excellent written and verbal communication skills, with the ability to deliver clear, constructive feedback to providers and coding staff
- Strong knowledge of medical terminology, disease processes, and physiology to accurately interpret complex clinical documentation
- Ability to work independently in a fast-paced environment while maintaining a high level of accuracy and meeting daily encounter targets
- Must live in Arizona
Why Join Our Team?
- Substantial growth opportunities
- Leadership and mentoring.
- Fun work environment (lunches, events, holiday parties)
- Comprehensive benefits (medical, vision, dental, 401k, paid holidays)
- Supportive and positive work culture