As a Certified Professional Medical Coding Auditor, your work at Tegria will focus on evaluating the accuracy, consistency, and quality of coded medical records completed by internal and external coding staff, conducting routine monthly and targeted audits to ensure adherence to official coding guidelines, payer requirements, regulatory standards, and organizational policies. 

This role completes audits, applying established coding guidelines and audit procedures to resolve most coding questions independently. The role may recommend improvements to coding procedures as guidelines and requirements evolve, escalates findings that may signal a compliance or revenue concern to coding leadership for evaluation, and provides supporting documentation that leadership relies on when determining next steps. 

The auditor identifies coding trends and improvement opportunities from completed audits and shares them with coding leadership. Partnering with the Coding Manager and Coding Leads, this role delivers clear, constructive feedback and helps support coder development, while championing accuracy, compliance, and revenue integrity throughout the organization. 

The role you play  

An effective Certified Professional Medical Coding Auditor will help the organization on a whole achieve success through: 

• Living our Tegria values: Respect Every Person, Act with Integrity, Strive for Better, Embrace Change, Deliver as a Team 

Coding Audits and Quality Reviews 

• Conduct audits according to the audit plan and methodology established by coding leadership, applying sound judgment within defined parameters. 

• Conduct retrospective and concurrent audits of coder-assigned ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and modifier codes. 

• Evaluate coding accuracy, completeness, consistency, and compliance with official coding guidelines and organizational standards. 

• Perform routine monthly quality assurance audits as well as focused reviews assigned by coding leadership. 

• Validate appropriate code assignment and sequencing based on provider documentation. 

• Apply sound coding judgment to resolve routine coding questions, escalating more complex or ambiguous coding requirements to a senior auditor or coding leadership for guidance. 

• Identify coding errors, trends, and opportunities for process improvement; flag potential compliance or revenue concerns to coding leadership for evaluation. 

• Monitor coding quality metrics and assist leadership with accuracy of scorecard development and reporting. 

• Participate in quality improvement initiatives designed to enhance coding performance and consistency across teams. 

Coder Feedback and Education 

• Provide timely, constructive, and individualized feedback to coders regarding audit findings. 

• Translate audit findings and coding trends into topics for education sessions and identify developmental needs, in partnership with coding leadership. 

• Contribute to and help deliver coding education sessions based on audit results, identified trends, and regulatory updates. 

• Create educational resources including tip sheets, coding guidance documents, case studies, and training materials. 

• Assist with onboarding and mentoring newly hired coders. 

• Partner with coding leadership to support corrective action plans and individualized education plans when needed. 

• Serve as a coding resource for staff and assist coders with complex coding questions. 

Compliance and Regulatory Support 

• Ensure coding practices comply with ICD-10-CM, CPT, HCPCS, CMS, Official Coding Guidelines, and payer requirements. 

• Recommend updates to coding procedures and guidance documents as guidelines, payer requirements, or organizational needs evolve. 

• Monitor regulatory and coding guideline changes and communicate their impact on coding staff and leadership. 

• Escalate audit findings and potential compliance risks to coding leadership and provide supporting documentation and input on possible remediation actions. 

• Assist with preparation for internal and external coding quality reviews. 

• Support organizational compliance initiatives related to coding quality and documentation integrity. 

Data Analysis and Reporting 

• Analyze audit data to identify patterns, trends, and educational opportunities. 

• Prepare audit reports and coding quality metrics for coding leadership, including findings and supporting documentation. 

• Track coder performance improvement over time and measure the effectiveness of educational interventions. 

• Provide recommendations for workflow improvements and process standardization. 

• Collaboration 

• Partner closely with the Coding Manager and Coding Leads to align audit findings, education, and coder development efforts with organizational goals. 

• Contribute to coding policy and procedure development. 

• Support organizational goals related to coding quality, compliance, and productivity. 

• Leverage approved AI tools to enhance productivity, accuracy, and decision making. 

• Performs other generally related duties as assigned. 

What we’re looking for  

We expect: 

• High school diploma or equivalent required;  

• Associates or Bachelor's degree in Health Information Management or related healthcare field preferred. 

• Current Certified Professional Medical Auditor (CPMA) certification, in addition to one of the following AAPC or AHIMA certifications:  

• Certified Professional Coder (CPC) 

• Certified Coding Specialist (CCS) 

• Certified Outpatient Coder (COC) 

• RHIT or RHIA 

• Minimum 3 years of medical coding experience in professional and/or facility coding. 

• Minimum 1 year of coding quality review, auditing, or coding education experience, with demonstrated ability to work with general direction and exercise sound judgment on coding issues. 

• Strong working knowledge of ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and official coding guidelines. 

• Solid understanding of coding quality methodologies and audit principles. 

• W2 project-based consultants will be expected to provide a computing device that adheres to industry standards and security best practices to use in satisfying the Project Services on behalf of Tegria 

Success Criteria 

People who are successful in this role… 

• Are productive, responsive, and reliable in a remote working environment. 

• Exercise sound, independent judgment on ambiguous or complex coding issues.  

• Demonstrate objectivity and consistency in evaluating others' work.  

• Communicate clearly and constructively, even when delivering critical feedback.  

• Stay current and adaptable as coding guidelines and regulations evolve.  

• Balance strong attention to detail with big-picture, trend-level thinking.  

• Build trust and credibility through sound, well-supported judgment.  

• Manage competing priorities and deadlines effectively.  

• Approach coaching and development with patience and a constructive mindset.  

• Take ownership and follow through on outcomes.