Medical Coding Auditor - Surgical Services

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care.
 

ESSENTIAL DUTIES AND RESPONSIBILITIES The responsibilities listed here represent the majority of the role but are not all-inclusive; other duties may be assigned.

• Accurately assign CPT, ICD-10-CM, and HCPCS Level II codes for professional surgical services based on thorough medical record review.
• Evaluate medical records for proper code assignment, completeness, accuracy, and support of medical necessity.
• Ensure coding compliance with CMS, commercial payer, and regulatory guidelines.
• Identify and address undercoding, overcoding, modifier misuse, and unbundling issues.
• Apply appropriate modifiers and ensure correct provider, place of service, and payer selection.
• Conduct claim review to support clean claim submission and reduce denials.
• Audit coding accuracy through ad hoc reports, focused reviews, and special projects.
• Analyze coding-related denials and recommend corrective actions.
• Review payer policies and stay current on annual coding updates and regulatory changes.
• Collaborate with providers and operational leadership to clarify documentation and improve coding specificity.
• Maintain productivity and quality benchmarks established by the department.
• Serve as a subject matter resource for surgical coding guidance within assigned service lines.

QUALIFICATIONS

Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• High-level knowledge of general surgery-related medical terminology, anatomy, and pathophysiology.
• Strong understanding of CPT procedure coding, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis coding.
• Knowledge of coding in surgical practices, ambulatory surgery centers, and hospital settings.
• Ability to evaluate documentation for medical necessity and coding compliance.
• Strong understanding of National Correct Coding Initiative (NCCI) edits and bundling guidelines.
• Ability to audit reports, conduct focused reviews, and participate in special projects.
• Advanced analytical and problem-solving skills.
• High attention to detail and accuracy.
• Proficiency with EHR systems, practice management systems, and claim scrubber tools.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency in Microsoft Office applications.
• Ability to maintain confidentiality and exercise professional discretion.

Education / Experience:  Include minimum education, technical training, and/or experience preferred to perform the job.

Required:

• High school diploma or equivalent.
• Minimum five (5) years of professional medical coding experience.
• Strong surgical coding experience required.
• Active coding certification through: American Academy of Professional Coders (AAPC) (ie. CPC), or American Health Information Management Association (AHIMA) (ie. CCS-P).

Preferred:

• Certified Professional Medical Auditor (CPMA) through AAPC.
• Experience conducting internal coding audits.
• Experience with CMS Part B and commercial payer reimbursement methodologies.

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms.
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job

• Hybrid office environment or flexible for remote 
  • Corporate office: 4835 Lyndon B Johnson Fwy, Dallas, TX 75244
• If remote, must reside in a state IES operates in
  • Arizona, Colorado, Texas, Oklahoma, Indiana, Missouri, Alabama, South Carolina, & Florida

TRAVEL:

• Some travel, including overnight and local, may be required as business needs dictate.

ADA & Reasonable Accommodation Statement:
IES is committed to providing equal employment opportunities to qualified individuals with disabilities. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. If you require accommodation during the application or employment process, please contact [email protected].

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.