Medical Coding Auditor

Description

Seeking a detail-oriented and knowledgeable Provider/Coding Auditor Educator to support accurate and compliant coding practices across our provider network. This role will be responsible for performing audits of medical documentation and coding, educating providers on best practices, and ensuring adherence to industry guidelines and payer regulations. The ideal candidate is a certified coding professional with strong communication skills and a passion for education and compliance. This role requires flexibility to travel to various provider locations for onsite education and auditing support, as needed

Requirements

Key Responsibilities

• Conduct prospective, concurrent, and retrospective coding audits for professional and/or facility services.
• Review medical documentation to ensure codes assigned (ICD-10-CM, CPT, HCPCS) are supported and meet regulatory and payer guidelines.
• Deliver coding and documentation education to providers through individual coaching, team sessions, and formal training presentations—both virtually and in person.
• Develop educational tools such as tip sheets, coding guides, and compliance reference materials.
• Identify trends in audit findings and provide feedback to leadership to guide quality improvement initiatives.
• Serve as a subject matter expert (SME) on coding policies, E/M documentation, and payer regulations.
• Support new provider onboarding and orientation with training on coding expectations and documentation standards.
• Collaborate with compliance, revenue cycle, and clinical operations teams to improve accuracy in coding and billing.
• Assist in the development and revision of policies, procedures, and training programs related to coding and documentation compliance.
• Maintain up-to-date knowledge of CMS guidelines, payer-specific rules, and industry coding updates.

Qualifications:

Education & Certification:

• Associate or bachelor’s degree in health information management, or a related healthcare field (preferred).
• Active coding certification required: CPC, CCS, or equivalent.
• CPMA (Certified Professional Medical Auditor) strongly preferred or must be obtained within 6 months of hire.
• Additional certifications (e.g., CRC, CCS-P, CDEO) are a plus.

Experience:

• Minimum of 3–5 years of experience in medical coding with direct auditing and provider education responsibilities.
• Proficient in Evaluation & Management (E/M) coding, outpatient and/or inpatient coding, and modifier usage.
• Experience in developing and delivering provider education in both individual and group settings.
• Prior experience using EMR/EHR systems and audit tools, or similar platforms.

Skills:

• In-depth knowledge of CPT, ICD-10-CM, and HCPCS coding and official coding guidelines.
• Strong communication and presentation skills with the ability to explain complex coding topics in an understandable way.
• High level of professionalism and discretion when delivering feedback.
• Ability to analyze trends and provide data-driven recommendations.
• Proficiency in Microsoft Office tools (Excel, PowerPoint, Word).

Other Requirements:

• Self-motivated and able to work independently and as part of a collaborative team.
• Flexible and adaptable to changing priorities and regulations.
• Willingness and ability to travel up to 25–40%, including occasional overnight stays for onsite education or audit support.

Key Physical & Mental Requirements:

• Ability to lift up to 50 pounds.
• Ability to push or pull heavy objects using up to 50 pounds of force.
• Ability to sit or stand for extended periods during training sessions or on-site support.
• Ability to use fine motor skills to operate office equipment and/or machinery.
• Ability to receive and comprehend instructions verbally and/or in writing.
• Ability to apply logical reasoning for simple and complex problem-solving.
• Ability to travel to multiple locations as required to support business needs.

Equal Opportunity Employer Statement:

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Alpharetta, GA 30022