Job Role Description

Banking & Finance > Coding Auditor

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Short Description:

A Coding Auditor is responsible for reviewing and analyzing medical records to ensure accurate assignment of diagnostic and procedural codes in compliance with coding standards and regulations. They identify discrepancies, errors, or inconsistencies and provide feedback to coding staff or healthcare providers to support proper documentation and billing. The role involves maintaining detailed records, preparing audit reports, and assisting with quality improvement initiatives. Coding Auditors help optimize revenue cycle accuracy, regulatory compliance, and data integrity. Strong attention to detail, analytical skills, and knowledge of medical coding systems are essential for success in this role.

Duties / Responsibilities:

  • Review medical records, billing statements, and coded data to ensure accuracy, completeness, and compliance with coding standards
  • Audit physician and clinical documentation to verify proper assignment of ICD-10, CPT, and HCPCS codes
  • Identify coding errors, discrepancies, or potential compliance issues and provide feedback to coding staff or clinical teams
  • Collaborate with Health Information Management (HIM), CDI, and billing teams to resolve documentation and coding issues
  • Monitor coding trends, performance metrics, and audit results to support continuous improvement initiatives
  • Maintain detailed records of audits, findings, and corrective actions in accordance with organizational and regulatory requirements
  • Provide education and guidance to coders, clinicians, and staff on coding rules, guidelines, and best practices
  • Participate in internal and external compliance audits to ensure adherence to federal, state, and payer regulations
  • Generate reports on coding accuracy, error rates, and audit outcomes for management review
  • Stay current on coding updates, industry regulations, and reimbursement methodologies

Skills / Requirements / Qualifications

  • Education: Associate’s or bachelor’s degree in Health Information Management, Nursing, or a related healthcare field preferred
  • Certifications: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required; auditing certification preferred
  • Experience: 2–5 years of experience in medical coding, billing, or auditing
  • Analytical Skills: Ability to identify discrepancies, interpret clinical documentation, and ensure accurate coding
  • Attention to Detail: High level of accuracy in reviewing records, coding assignments, and audit documentation
  • Regulatory Knowledge: Strong understanding of ICD-10, CPT, HCPCS coding, and healthcare compliance standards
  • Communication: Effective verbal and written skills for providing feedback and collaborating with clinical and coding teams
  • Problem-Solving: Ability to recommend solutions, resolve coding issues, and implement process improvements

Job Zones

  • Title: Job Zone Four: Considerable Preparation Needed
  • Education: Most of these occupations require a four-year bachelor's degree, but some do not. 
  • Related Experience: A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. 
  • Job Training: Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
  • Job Zone Examples: Many of these occupations involve coordinating, supervising, managing, or training others. 
  • Specific Vocational Preparation in years: 2-4 years preparation (7.0 to < 8.0)

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