California Licensed Medical Coding Auditor

Job Summary

To support a leading healthcare company, the part-time California Licensed Medical Coding Auditor will conduct risk-based audits on professional coding and billing workflows, validating code assignments and compliance remotely.

Key responsibilities

• Validate code assignment, documentation, medical necessity, and modifier usage through prospective and retrospective audits
• Analyze error trends and financial impacts while developing appropriate audit samples and maintaining consistent documentation
• Communicate findings and recommend improvements to physicians and APCs, managing multiple concurrent audits and reporting deadlines

Required qualifications

• 5+ years of professional coding, billing, or healthcare audit experience, including risk-based auditing
• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, and current E/M guidelines
• Experience with Medicare, Medi-Cal, and commercial payer policies, including CMS manuals and NCDs/LCDs
• Proficiency in Epic charge review and coding documentation
• Ability to analyze audit results and develop defensible audit samples