CODING AUDITOR

Job Description

About Legent Health

At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.”

Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.”

Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.

Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.

Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

About the Role

The Coding Auditor is responsible for ensuring the accuracy, compliance, and quality of medical coding within a healthcare network. This role involves conducting audits, providing feedback to coding professionals, and ensuring adherence to regulatory guidelines, payer policies, and coding best practices. The Coding Auditor will work closely with medical staff, billing teams, and compliance departments to enhance coding accuracy and optimize reimbursement.

POSITION’S ESSENTIAL RESPONSIBILITIES:

Conduct routine and focused coding audits to assess compliance with ICD-10, CPT, HCPCS, and other applicable coding guidelines.

Analyze medical records to ensure accurate code assignment and adherence to healthcare regulations, payer policies, and internal standards.

Identify coding discrepancies, trends, and potential areas for improvement, providing corrective action recommendations.

Develop and deliver educational training to coding staff and healthcare providers on coding updates, documentation improvement, and compliance requirements.

Collaborate with revenue cycle teams to ensure proper claims submission and minimize denials due to coding errors.

Assist in the development and implementation of coding policies and procedures to maintain compliance with federal and state regulations.

Maintain up-to-date knowledge of coding guidelines, payer rules, and regulatory changes, disseminating relevant information to stakeholders.

Generate reports and summaries of audit findings, presenting data-driven insights to management.

Support internal and external compliance audits by ensuring documentation and coding accuracy align with established standards.

Audit coded cases that have been denied by insurance to determine if coding errors exist.

Answer coding related questions from senior leadership on outstanding accounts receivable.

Required Skills/Abilities:

Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRGs, and medical terminology.

Familiarity with healthcare reimbursement methodologies, including Medicare and Medicaid guidelines.

Familiarity with major payor medical necessity policies.

Experience using electronic health records (EHR) and coding software.

Excellent analytical, communication, and problem-solving skills.

Detail-oriented with the ability to work independently and manage multiple tasks efficiently.

Education and Experience:

Associate’s or Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field preferred.

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.

Minimum of 5 years of medical coding and 2-3 years of auditing experience in a healthcare setting.

Preferred Qualifications:

Experience in network-based healthcare systems, hospital settings, or large medical groups.

Additional certifications such as Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) are a plus.

Knowledge of risk adjustment and hierarchical condition category (HCC) coding.

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

Competitive salary and performance incentives

Comprehensive benefits package

Paid time off and wellness programs

Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance:

Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.

#legenthiring

Full-time