Accessibility Note:
Surgery Partners is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended (“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualified people or applicant with regard to any terms or conditions of employment on the basis of such individual’s disability. Consistent with this policy of non-discrimination, the Company will provide reasonable accommodations to an individual with a disability, as defined in the ADA or applicable law, who has made the Company aware of his/her disability, unless doing so would cause an undue hardship to the Company. If you are an applicant and need a reasonable accommodation when applying for job opportunities within the Company or request a reasonable accommodation to utilize the Company’s online employment application, please contact talentacquisition@surgerypartners.com
General Summary
The Coding Auditor is responsible for evaluating and improving the quality, accuracy, compliance, and consistency of coding performed by internal and outsourced coding vendors across multiple healthcare service lines, including Ambulatory Surgery Centers (ASC), Professional Fee, Hospital Outpatient, and future coding programs.
Reporting directly to the Coding Vendor Manager, this position performs comprehensive coding audits, identifies trends and educational opportunities, monitors all internal and vendor compliance with organizational coding standards, payer requirements, and regulatory guidelines, and assists with performance improvement initiatives.
Essential Responsibilities
- Perform routine and targeted audits of internal and outsourced coding vendors.
- Conduct pre-bill, post-bill, focused, and retrospective audits.
- Evaluate coding accuracy, modifier usage, sequencing, documentation support, and compliance.
- Review ICD-10-CM, ICD-10-PCS, CPT, HCPCS, CMS, NCCI, payer policies, and organizational standards.
- Validate documentation and medical necessity.
- Monitor coding quality and trends.
- Assist with scorecards and corrective action plans.
- Support internal/external audits and regulatory compliance.
- Provide coder education and feedback.
- Partner with Revenue Integrity, HIM, Compliance, CDI, and Operations.
- Prepare audit reports, dashboards, and trend analyses.
- Recommend process improvements and maintain coding policies.
Supervisory Responsibilities
- No direct supervisory responsibility. Serves as coding subject matter expert and provides audit feedback and education under the direction of the Coding Vendor Manager.
Knowledge, Skills & Abilities
- Advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS, CMS, NCCI, ASC, Hospital Outpatient, and Professional Fee coding.
- Strong analytical, communication, auditing, and documentation review skills.
- Experience with encoder systems, EHRs, auditing software, Excel, and Microsoft Office.
Education & Experience
- Bachelor's degree preferred or equivalent experience.
- Minimum 5 years coding experience.
- Minimum 3 years coding audit experience.
- Experience auditing ASC, Hospital Outpatient, and Professional Fee coding.
- Vendor auditing experience preferred.
Preferred Certifications
- CCS, CPC, CCS-P, RHIA, and/or RHIT
- CPMA a plus
Key Performance Indicators
- Coding accuracy
- Audit completion timeliness
- Quality scores
- Reduction in repeat errors
- Denial reduction
- Compliance
- Educational effectiveness
Work Environment
- Primarily remote with occasional travel supporting 58+ facility and vendor meetings, audits, and organizational initiatives.
Equal Employment Opportunity & Work Force Diversity
Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws. This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc. Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.
Surgery Partners conducts pre-employment screenings including but not limited to criminal background checks and drug testing.