E/M Coding Auditor

E/M Coding Auditor

Position Summary

The E/M Coding Auditor conducts routine evaluation and management (E/M) coding audits across assigned specialties, providers, coders, and client accounts to assess coding accuracy, documentation sufficiency, and compliance with applicable E/M guidelines and payer requirements. This role is responsible for producing well-documented audit findings, supporting corrective action follow-through, and contributing to the department's compliance monitoring and education efforts. The E/M Coding Auditor works closely with the Senior Coding Auditor and Coding Audit Manager to develop technical skills, deliver consistent audit quality, and grow into an increasingly independent contributor within the audit program.

Key Responsibilities

Audit Execution

• Conduct routine E/M coding audits across assigned specialties, providers, and client accounts, reviewing clinical documentation and coded encounters for accuracy, documentation alignment, and compliance with applicable guidelines
• Evaluate the relationship between clinical documentation and reported E/M codes, including patient status, place of service, level of service (MDM or total time), modifiers, and add-on or prolonged services
• Apply AMA CPT E/M guidelines, CMS policies, ICD-10-CM, HCPCS, modifier rules, and payer-specific requirements to audit findings; support determinations with authoritative coding, regulatory, and payer references per departmental guidance
• Complete assigned audit volumes within established turnaround expectations and quality standards
• Perform assigned audits independently within established departmental guidelines and audit methodology. Escalate complex scenarios (e.g., split/shared visits, teaching physician rules, critical care) or conflicting guidance to the Senior Coding Auditor
• Participate in audit calibration activities to promote consistency in audit interpretation and application of E/M guidelines

Finding Documentation & Reporting

• Document audit findings with accuracy and clarity, including discrepancy identification (e.g., over-coding, under-coding), root cause classification, and corrective recommendations
• Prepare individual audit reports and summary submissions per department templates and standards
• Maintain organized, complete audit records and files per department documentation requirements
• Compile audit data, including E/M level distribution and accuracy rates, for submission to the Coding Audit Manager for trend analysis and reporting

Corrective Action & Education Support

• Communicate audit findings to audited coders and providers in a professional, constructive, and guideline-grounded manner
• Provide individualized E/M coding and documentation feedback and assist with audit-driven education, including written feedback, reference materials, and team huddles or education sessions
• Assist in re-auditing previously identified findings to assess corrective action effectiveness
• Identify patterns in assigned audit findings, such as level-of-service outliers or recurring documentation gaps, and report observations to the Coding Audit Manager and Senior Coding Auditor

Compliance Monitoring & Confidentiality

• Remain current with applicable AMA CPT E/M guideline changes, CMS and payer updates, and regulatory requirements relevant to assigned specialties
• Flag potential compliance risks or emerging accuracy issues identified during audit activity to the Senior Coding Auditor or Coding Audit Manager
• Support audit readiness activities and contribute to audit program documentation as directed
• Maintain confidentiality and safeguard protected health information in accordance with HIPAA, organizational policies, and applicable regulatory requirements

Key Performance Indicators

• Audit completion rate and turnaround time against assigned schedule
• Audit finding accuracy and documentation quality (validated through supervisor review and calibration)
• Escalation timeliness and appropriateness
• Quality of corrective feedback delivered to audited coders and providers
• Contribution to re-audit completion and corrective action follow-through
• Audit consistency and adherence to established audit methodology and departmental standards

Experience & Requirements

• Active CPMA plus one or more of the following required: CPC, CCS, RHIT, RHIA
• 5+ years of E/M coding experience with at least 1 year of coding audit experience; 2+ years preferred; working knowledge of current AMA CPT E/M and CMS documentation guidelines
• Proficiency in Microsoft Office applications (Excel, Word, Outlook); experience with reporting and data analysis tools preferred
• Proven ability to multi-task, prioritize workload, and meet deadlines in a fast-paced environment
• Strong communication and interpersonal skills

Additional Qualifications

• Exceptional attention to detail and organizational skills.
• Ability to work independently while contributing to a team-oriented environment
• Demonstrated problem-solving skills with a proactive and solution-driven approach