Position Summary
The Quality Auditor serves as a subject matter expert in both surgical and professional CPT coding, supporting coding quality, compliance, and education initiatives as an individual contributor. This role is responsible for performing coding audits, analyzing quality trends, and delivering targeted education to coders. The position partners closely with internal operations teams to ensure coding accuracy, regulatory compliance, and adherence to payer and client requirements, while contributing to continuous quality and process improvement efforts.

Key Responsibilities

· Perform quality reviews of ASC and professional surgical coding, including CPT, ICD-10-CM, modifier assignment, and compliance with Official Coding Guidelines, NCCI/OCE edits, and payer policies.

· Support and maintain the coding quality assurance program, including audit methodologies, scoring, documentation standards, and quality tracking processes.

· Analyze audit results and quality trends to identify risk areas, educational needs, and opportunities for process improvement.

· Develop and deliver targeted coder education, including remediation, training sessions, and client-specific education as needed.

· Prepare client-facing audit summaries and reports that communicate quality scores, trends, and recommended actions clearly and professionally.

· Collaborate with Coding Operations and cross-functional teams to support workflow optimization, standardization of best practices, and achievement of quality and service-level expectations.

· Provide expert-level support for complex coding questions across Ambulatory Surgery Centers and Professional Fee services.

· Participate in quality and compliance initiatives, including follow-up audits, monitoring of corrective actions, and validation of improvement outcomes.

· Contribute to special projects related to audits, quality improvement, workflow enhancements, client onboarding, and ongoing client support.

Qualifications

· Credentials: Active AAPC or AHIMA credential (CPC, CCS, RHIT, or RHIA required).

· Experience:

o 8–10+ years of coding experience, including outpatient and/or professional surgical coding.

o 5+ years of coding quality auditing and/or coding education experience.

· Technical Expertise:

o Advanced knowledge of CPT, ICD-10-CM, modifier usage, Medicare regulations, OPPS, and payer policies.

o Experience with multiple surgical specialties such as orthopedics, spine, pain management, ophthalmology, and general surgery.

· Skills & Competencies:

o Strong written and verbal communication skills, including education and presentation capabilities.

o Excellent analytical skills with the ability to interpret audit data and translate findings into actionable education.

o Highly organized with the ability to manage multiple priorities and meet deadlines in a fast-paced, remote environment.

o Self-directed, solution-oriented mindset with strong critical thinking and problem-solving abilities.

o Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint.