医疗-编码质量审计师负责人
Lead - Healthcare - Coding Quality Auditor
人工智能。自动化。云工程。高级分析。
对于企业而言，这些是成功的关键因素。对我们而言，它们是我们核心的专业领域。
我们与全球知名品牌合作。我们通过市场领先的科技和卓越的业务流程，为他们带来独特的价值主张。其中心是数字工程——这是推动快速创新和可扩展业务转型的基础。
我们已创造363项独特且独立的发明，其中250项基于人工智能，并在关键科技领域获得多项专利授权。借助我们先进的产品和平台，我们实现大规模的数字化转型，优化关键业务运营，重塑体验，开创新解决方案，所有这些都通过无缝的“即服务”模式提供。
对每家公司，我们为其业务、所合作的人以及所服务的客户带来新的钥匙。凭借经验证的战略和敏捷执行，我们不仅推动变革——我们打造数字成果。
Sutherland
数字成果。
医学编码审计员负责通过审查医疗记录和编码实践，确保准确分配ICD-10-CM、CPT和HCPCS第II级代码，以符合联邦、州、保险公司和组织的指南。该职位评估编码准确性，识别文档不足之处，进行审计，向编码人员和医务人员提供教育，并支持收入周期的完整性，同时最小化合规风险。
主要职责和责任
· 对住院、门诊、医生和/或专科服务进行回顾性、同期性和前瞻性编码审计。
· 审查医疗文档，验证所分配诊断和程序代码的准确性和完整性。
· 确保符合ICD-10-CM、ICD-10-PCS、CPT、HCPCS第II级、医保、医疗补助、商业保险公司和监管指南。
· 识别编码错误、文档缺口和报销机会。
· 准备详细的审计报告，列出发现、趋势、建议和纠正措施。
· 向编码人员、医务人员和临床人员提供一对一和小组教育，内容包括编码更新、文档改进和合规要求。
· 监控编码质量指标并制定行动计划以提高编码准确性和一致性。
· 跟踪最新的编码法规、官方编码指南
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Artificial Intelligence. Automation. Cloud Engineering. Advanced Analytics.
For Enterprises, these are key factors of success. For us, they're our core expertise.
We work with global iconic brands. We bring them a unique value proposition through market-leading technologies and business process excellence. At the heart of it all is Digital Engineering - the foundation that powers rapid innovation and scalable business transformation.
We've created 363 unique and independent inventions, 250 of which are AI-based and rolled up under several patent grants in critical technologies. Leveraging our advanced products and platforms, we drive digital transformation at scale, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless "as-a-service" model.
For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. With proven strategies and agile execution, we don't just enable change - we engineer digital outcomes.
Sutherland
Digital Outcomes.
The Medical Coding Auditor is responsible for keeping Sutherland coders in compliance by reviewing medical records and coding practices to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in compliance with federal, state, payer, and organizational guidelines. This role evaluates coding accuracy, identifies documentation deficiencies, conducts audits, provides education to coding staff and providers, and supports revenue cycle integrity while minimizing compliance risk.
Essential Duties and Responsibilities
· Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and/or specialty services.
· Review medical documentation to validate the accuracy and completeness of assigned diagnosis and procedure codes.
· Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines.
· Identify coding errors, documentation gaps, and reimbursement opportunities.
· Prepare detailed audit reports outlining findings, trends, recommendations, and corrective actions.
· Provide one-on-one and group education to coders, providers, and clinical staff regarding coding updates, documentation improvement, and compliance requirements.
· Monitor coding quality metrics and develop action plans to improve coding accuracy and consistency.
· Stay current on coding regulations, Official Coding Guidelines, CMS regulations, payer policies, and industry best practices.
· Assist with internal and external audits, payer reviews, and regulatory investigations.
· Maintain confidentiality of protected health information (PHI) in accordance with HIPAA regulations.
· Participate in policy development, process improvement initiatives, and coding education programs.
· Track audit results and identify recurring trends to support continuous quality improvement.
Qualifications
· Minimum of 3-5 years of medical coding experience in a healthcare setting.
· Minimum of 2 years of coding audit or quality review experience preferred.
· Current coding certification such as:
· Certified Professional Coder (CPC)
· Certified Professional Medical Auditor (CPMA)
· Certified Coding Specialist (CCS)
· Certified Inpatient Coder (CIC)
· Registered Health Information Technician (RHIT) or
· Registered Health Information Administrator (RHIA) preferred
· Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems.
· Strong understanding of CMS regulations, National Correct Coding Initiative (NCCI), Official Coding Guidelines, and payer-specific policies.
· Experience with electronic health records (EHR) and encoder software.
Knowledge, Skills, and Abilities
· Exceptional analytical and critical thinking skills.
· Strong knowledge of healthcare reimbursement methodologies.
· Ability to interpret complex clinical documentation.
· Excellent written and verbal communication skills.
· Strong attention to detail and organizational abilities.
· Ability to maintain objectivity while providing constructive feedback.
· Proficiency with Microsoft Office Suite and coding/audit software.
· Ability to work independently and collaboratively in a fast-paced environment.
All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.