Facility Outpatient Auditor - ED, SDS, OBS, I&I

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Facility Outpatient Auditor – ED, SDS, OBS, I&I based in the United States. In this role, you will help ensure the accuracy, quality, and compliance of hospital outpatient coding and billing across emergency department (ED), same-day surgery (SDS), observation services (OBS), and infusion and injection (I&I) settings. You will conduct detailed medical record audits, identify coding discrepancies, and assess documentation against established clinical coding and reimbursement guidelines. By analyzing audit findings and identifying root causes, you will help improve coding accuracy, reduce denials, and support appropriate reimbursement. You will collaborate with coding professionals and internal stakeholders to provide technical guidance, deliver training, and strengthen quality assurance practices. Your expertise will contribute to maintaining regulatory compliance, protecting patient information, and improving revenue cycle performance. This fully remote opportunity is suited to a detail-oriented coding professional who enjoys analytical work, continuous learning, and helping teams achieve consistently high standards. Accountabilities - Conduct outpatient coding audits: Perform complex retrospective reviews of medical records to identify coding and billing errors, inconsistencies, documentation gaps, and compliance risks across ED, SDS, OBS, and I&I services. - Validate coding accuracy and reimbursement: Conduct second-level reviews of diagnosis codes, procedure codes, and billing practices to ensure compliance with applicable coding standards, regulatory requirements, and reimbursement policies.

- Apply official coding guidelines: Interpret and apply guidance from the American Hospital Association (AHA), Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), Coding Clinic , CPT Assistant, and other relevant authoritative sources. - Analyze audit findings: Investigate coding discrepancies, identify root causes, recognize recurring quality issues, and recommend corrective actions to prevent errors from recurring. - Support compliance and denial resolution: Research and respond to inquiries concerning coding compliance, inappropriate coding, claim denials, billable services, medical necessity, and third-party payer requirements. - Provide technical guidance and training: Educate coding staff on documentation standards, coding guidelines, regulatory changes, reimbursement methodologies, and compliance requirements. - Identify documentation improvement opportunities: Recognize when physician queries may be necessary based on clinical information, documentation gaps, and accurate code assignment requirements. - Monitor coding quality and productivity: Track coder performance, review ongoing quality results, identify areas requiring improvement, and help maintain a minimum overall coder accuracy rate of 95%. - Maintain quality assurance standards: Keep quality review percentages as close as possible to the internal target of 10%, while ensuring appropriate monitoring and timely resolution of coding issues. - Develop reports and deliverables: Prepare monthly reports, audit findings, coder feedback, status updates, and other required documentation for management and operational stakeholders. - Improve coding workflows: Contribute to the design and enhancement of systems, processes, and tools that improve coding accuracy, productivity, and operational efficiency. - Maintain professional standards: Keep coding credentials current and remain informed about changes in coding practices, reimbursement methodologies, regulatory requirements, and compliance expectations.