Auditor

About the Company

Location: Chennai

Work Mode: Chennai (Work from Office / Hybrid as per business need)

About the Role

Job Description: Medical Coding – E&M & Surgery LI Auditor

Designation: Senior Executive / Team Lead – Quality Auditor (E&M & Surgery)

Job Summary

• We are seeking an experienced E&M and Surgery LI Auditor to review, audit, and ensure the accuracy of medical coding for Evaluation & Management (E&M) and Surgical specialties.
• The candidate will be responsible for validating coding accuracy, ensuring compliance with payer and client guidelines, identifying coding opportunities, and providing feedback to coding teams.

Responsibilities

• Audit E&M (Office, Hospital, Consultations, Observation) medical records for coding accuracy.
• Perform audits on Surgical coding including CPT, ICD-10-CM, HCPCS, and modifier usage.
• Review Level of Service (LOS) assignment as per current E&M documentation guidelines.
• Identify undercoding, overcoding, and compliance risks.
• Ensure adherence to CMS, AMA, payer-specific, and client requirements.
• Provide audit feedback, error analysis, and coaching to coders.
• Track and publish audit quality reports and trends.
• Participate in calibration sessions and quality improvement initiatives.
• Support internal and external compliance audits.

Qualifications

• Qualification: Any Graduate with Medical Coding Certification (CPC preferred)

Required Skills

• Strong knowledge of E&M Coding Guidelines (2021 onwards).
• Expertise in Surgery Coding across multiple specialties.
• Proficient in CPT, ICD-10-CM, HCPCS, Modifiers, NCCI Edits, LCD/NCD guidelines.
• Experience in auditing professional fee coding.
• Ability to analyze medical records and physician documentation.
• Excellent communication and feedback delivery skills.

Preferred Skills

• Experience with US Healthcare RCM and coding compliance.
• Additional certifications such as COC, CIC, CPMA preferred.

Pay range and compensation package

Not specified.

Equal Opportunity Statement

Not specified.

Additional Details

Eligibility

• 3-8 years of experience in Medical Coding.
• Minimum 2+ years of experience in E&M and Surgery Auditing.
• Certified Professional Coder (CPC) mandatory.
• Additional certifications such as COC, CIC, CPMA preferred.
• Experience with US Healthcare RCM and coding compliance.

Preferred Specialties

• General Surgery
• Orthopedic Surgery
• Cardiovascular Surgery
• Neurosurgery
• Gastroenterology
• ENT
• Urology

Key Performance Indicators (KPIs)

• Audit Accuracy ≥ 95%
• Productivity as per client benchmark
• Compliance Score ≥ 98%
• Timely completion of audit reports and feedback

Shift

• General Shift / Flexible based on client requirements