External Auditor

Scope

Pro fee coder with a minimum of 3 years’ experience auditing EM and procedures across multiple specialties in particularly radiology, neuro and ortho at a trauma 1 facility. Epic experience required and Codify experience preferred.  Schedule will be M-F preferably between 8am and 5 pm CST, be the start time can be flexible within reason.  For the first week of training candidates would need to be available 8a-5p CST

Core Coding & Audit Expertise

• Advanced proficiency in CPT, HCPCS Level II, and ICD-10-CM coding guidelines
• Strong expertise in Evaluation & Management (E/M) coding (office, hospital, consults, ED, critical care)
• Extensive experience auditing procedure-based coding across multiple specialties (e.g., cardiology, orthopedics, radiology, neurosurgery, general surgery)
• In-depth knowledge of NCCI edits, MUEs, modifier usage, and bundling/unbundling rules
• Ability to evaluate and validate medical necessity and accurate code assignment

Multi-Specialty Audit Experience

• Proven experience auditing professional fee coding across multiple specialties, such as:
  • Orthopedics
  • Cardiology
  • Radiology
  • Neurology/Neurosurgery
  • General Surgery
  • Internal Medicine / Hospitalist
• Ability to quickly interpret specialty-specific documentation and apply appropriate coding rules

Compliance & Regulatory Knowledge

• Strong knowledge of CMS guidelines, payer policies, and federal/state compliance requirements
• Familiarity with OIG Work Plan, audit risk areas, and regulatory updates
• Experience supporting internal and external audits, including payer audits and RAC reviews
• Ability to identify coding trends, compliance risks, and revenue leakage

Audit & Quality Management Skills

• Experience conducting retrospective and concurrent coding audits
• Ability to calculate and report accuracy rates, error categorization, and financial impact
• Skilled in developing audit reports, scorecards, and executive summaries
• Experience creating and delivering education and feedback to coders and providers
• Strong focus on continuous quality improvement and audit calibration processes

Documentation Review & Clinical Knowledge

• Strong understanding of clinical documentation requirements to support both E/M and procedural services
• Ability to identify documentation gaps and provide actionable recommendations
• Working knowledge of medical terminology, anatomy, physiology, and disease processes across specialties

Communication & Leadership Skills

• Ability to clearly communicate audit findings, rationale, and coding guidelines to stakeholders
• Experience collaborating with providers, coding teams, CDI, and operational leadership
• Strong presentation skills for delivering education sessions and audit results
• Ability to mentor and guide coders to improve quality and compliance performance

1. 3 + years' experience auditing pro fee across multiple specialties
2. Epic experience
3. Prefer Codify experience
4. Able to work M-F with the majority of the shift between 8a-5p CST
5. Able to pick up new workflows and technology easily
6. Able to ramp up productivity in 4 weeks
7. Maintain 95% accuracy in all coding
8. Good written and verbal communication