Outpatient Innovations Auditor

JOB SUMMARY:

The Outpatient Innovations Auditor performs quality assurance reviews of facility-based outpatient records processed through Autonomous Coding solutions. This role evaluates AI-generated coding results, compares them with human-coded results and supporting documentation, and identifies variances, trends, root causes, and opportunities to improve coding quality and technology performance. Applicable chart types may include Emergency Department, Observation, Same Day Surgery, Ancillary, Interventional Radiology, and Facility-Based Clinic services. The Auditor validates accurate code assignment and data abstraction in client electronic medical record and coding systems in accordance with Official ICD-10-CM Guidelines for Coding and Reporting, AMA CPT guidelines, HCPCS guidance, CMS directives, client-specific requirements, and applicable compliance standards. Working collaboratively with customers, the Innovations team, Coding Operations, and other stakeholders, this role communicates findings, supports issue resolution and testing, recommends workflow or solution enhancements, and provides education as needed. The Outpatient Innovations Auditor is expected to maintain an audit accuracy rate of 95% or better while meeting agreed-upon productivity, turnaround time, and documentation standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Complete all regularly scheduled quality assurance reviews for clients
• Review Autonomous Coding records to evaluate the accuracy, completeness, and appropriateness of AI-generated ICD-10-CM, CPT, and HCPCS code assignments
• Compare AI-generated results with human-coded results and the source documentation, documenting coding variances and the rationale for final determinations
• Analyze recurring variance patterns, false positives, false negatives, and workflow exceptions; escalate potential compliance, configuration, or performance concerns promptly
• Collaborate with customers and the Innovations team to clarify requirements, review findings, resolve discrepancies, and recommend improvements to coding logic, workflows, and quality controls.
• Support solution validation, user acceptance testing, release readiness, and post-implementation monitoring by executing defined test scenarios and documenting results.
• Maintain clear, reproducible audit documentation and summarize accuracy, variance, and trend results for internal and customer-facing reporting.
• Communicate quality issues to management as appropriate
• Respond to client QA needs at the direction of management
• Demonstrate knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
• Attend educational conference calls
• Perform other duties as needed within the scope of the project
• Maintain required productivity and quality requirements
• Maintain coding credential requirements

REQUIRED QUALIFICATIONS:

• Candidate must possess an approved AHIMA or AAPC coding credential;
• Minimum 5 years’ coding experience required; specialty experience may be preferred as per specific client needs
• Experience with all aspects of Outpatient charts such as SDS, ED, Ancillary, Observations, and IVR
• Minimum 2 years of auditing experience
• Experience auditing technology-assisted, computer-assisted, or autonomous coding results is preferred
• Demonstrated ability to interpret audit findings, analyze coding variances, and communicate evidence-based recommendations to customers and cross-functional teams
• 2 years of remote working experience preferred
• Proficiency with electronic health records, encoder or coding platforms, audit tools, and spreadsheet-based data review is preferred

KEY SUCCESS ATTRIBUTES:

• Integrity, passion, and ethics are required
• Demonstrates strong collaboration skills
• Has strong analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment
• Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
• Ability to self-motivate and self-direct
• Possess strong time management and organizational skills
• Commitment and adherence to company Core Values
  

CORE COMPETENCIES:

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability
• Meeting Standards

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

This role requires prolonged periods of desk working on a computer

Talking, hearing, and near vision are required to perform computer-based tasks and virtual communications

Sensory perception (visual, auditory, and tactile) is essential for computer and phone use

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

This is a remote role; work is performed in a home office environment.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.