The CRM for more than just salespeople. A relationship-focused CRM for your entire team.
Quality Auditor – Medical Coding
Location
India
Posted
157 days ago
Salary
0
Seniority
Lead
Job Description
Quality Auditor – Medical Coding
Nimble
• Perform quality reviews of ASC and professional surgical coding, including CPT, ICD-10-CM, modifier assignment, and compliance with Official Coding Guidelines, NCCI/OCE edits, and payer policies • Support and maintain the coding quality assurance program, including audit methodologies, scoring, documentation standards, and quality tracking processes • Analyze audit results and quality trends to identify risk areas, educational needs, and opportunities for process improvement • Develop and deliver targeted coder education, including remediation, training sessions, and client-specific education as needed • Prepare client-facing audit summaries and reports that communicate quality scores, trends, and recommended actions clearly and professionally • Collaborate with Coding Operations and cross-functional teams to support workflow optimization, standardization of best practices, and achievement of quality and service-level expectations • Provide expert-level support for complex coding questions across Ambulatory Surgery Centers and Professional Fee Services • Participate in quality and compliance initiatives, including follow-up audits, monitoring of corrective actions, and validation of improvement outcomes • Contribute to special projects related to audits, quality improvement, workflow enhancements, client onboarding, and ongoing client support
Job Requirements
- Active AAPC or AHIMA credential (CPC, CCS, RHIT, or RHIA required)
- 8–10+ years of coding experience, including outpatient and/or professional surgical coding
- 5+ years of coding quality auditing and/or coding education experience
- Advanced knowledge of CPT, ICD-10-CM, modifier usage, Medicare regulations, OPPS, and payer policies
- Experience with multiple surgical specialties such as orthopedics, spine, pain management, ophthalmology, and general surgery
- Strong written and verbal communication skills, including education and presentation capabilities
- Excellent analytical skills with the ability to interpret audit data and translate findings into actionable education
- Highly organized with the ability to manage multiple priorities and meet deadlines in a fast-paced, remote environment
- Self-directed, solution-oriented mindset with strong critical thinking and problem-solving abilities
- Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint
Benefits
- Career growth opportunities
- Work-life balance
Related Guides
Related Categories
Related Job Pages
More Auditor Jobs
Smart Contract Auditor
NethermindBuilders & researchers with expertise in Ethereum, Protocol Engineering, L2, DeFi & Smart Contracts Security & Auditing
• Work directly with protocols in the Ethereum and StarkNet ecosystems to review their code and help secure their protocols; • Collaborate with teammates to maintain and continually improve our existing blockchain security tools using modern software engineering practices; • Develop new blockchain security tools; • Engage in meetings with clients to discuss security and best practice improvements.
• Receive, log, and validate incoming stop-loss claims and related documentation • Verify eligibility, plan benefits, and stop-loss policy provisions • Accurately enter claim details into the system of record • Maintain electronic claim files for audit and compliance purposes • Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims • Identify cost-containment opportunities and implement strategies with carriers and TPAs • Document audit findings and maintain accurate records in the system • Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams • Offer guidance to clients on claims procedures and coverage issues • Ensure adherence to regulatory requirements, internal controls, and fraud prevention policies • Stay current on industry trends, regulations, and best practices • Identify opportunities to streamline claim intake and processing workflows • Train and mentor junior claims processors on best practices
DRG Validation Coding Auditor
Ensemble Health PartnersEnsemble Health Partners is a hospital and healthcare company that partners with client hospitals to help them develop processes, train teams, reach their financial and operational
• Perform documentation and coding audits for all acute inpatient services for clients • Identify coding errors, compliance, and educational opportunities • Optimize reimbursement by ensuring accurate codes and documentation • Conduct independent reviews and apply coding principles • Verify coding accuracy and clinical indicators • Maintain productivity and quality goals
• Directs, provides guidance and advice, and reviews the work product of more junior Auditors and Financial Analysts to ensure that it meets the stated objectives of audit investigations. • Reports to the Trial Staff and COR as required on the status of audit investigations; prepares interim and final written reports and recommendations based on the results of audit investigations. • Reviews and analyzes financial and operating statements, records and other information in order to arrive at results and conclusions in accordance with the stated objectives of audit investigations.
