Position Summary

The RCS Medical Coding Auditor is responsible for auditing professional (ProFee) medical coding to ensure accuracy, compliance, and alignment with AMA CPT, CMS, NCCI and payer guidelines. This role supports coding integrity, mitigates compliance risk, and drives continuous quality improvement through targeted education and audit-based feedback.

The ideal candidate brings strong hands-on experience with professional fee coding, deep knowledge of E/M, surgical, and modifier use, and the ability to translate audit findings into actionable insights.

Key Responsibilities

• Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback
• Validate ICD‑10‑CM, CPT®, HCPCS, and modifier assignment against clinical documentation to ensure accuracy and compliance with AMA CPT, ICD-10, CMS, NCCI, and payer-specific guidelines
• Conduct medical chart audits of professional services across multiple specialties
• Identify coding discrepancies, compliance risks, trends, root causes, and documentation gaps
• Support coding education through feedback, targeted training, and reference materials
• Prepare clear, defensible audit documentation including rationale and references
• Provide actionable recommendations to address audit findings and reduce future risk
• Track audit outcomes and trends to support leadership reporting and risk mitigation strategies
• Support denial prevention, resolution and appeal strategies
• Collaborate across teams to assist with coding support
• Maintain confidentiality and comply with HIPAA and organizational policies

Required Qualifications

• CPC (Required) and CPMA (Required/In Process)
• 2+ years of ProFee auditing experience
• Knowledge of:
  • E/M documentation guidelines
  • Modifier rules and NCCI edits
  • CPT, ICD‑10‑CM, HCPCS Level II
• High attention to detail with strong analytical and critical‑thinking skills
• Excellent written and verbal communication skills for audit reporting and education
• Proficiency with EHRs, coding and auditing tools
• Proficiency with Microsoft Office Suite

Preferred Qualifications

• Multi-specialty coding and auditing experience with preferred background in E/M Coding, Orthopedics, Pain Management, Urology
• Background in coding quality programs or compliance teams
• Advanced reporting skills for audit tracking and trend analysis
• Prior consulting or client‑facing audit experience

Compensation Range:

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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