Job Summary

Coding Education & Quality Auditors (CEQA) conduct coding/billing/documentation audits of all NGPG/NGHS Providers to determine organizational integrity of coding/billing for professional services, including detection and correction of documentation, coding and billing errors. Audits consist of evaluation of the adequacy and accuracy of documentation to support services billed including ICD-9/ICD10/CPT/HCSPCS and other third-party payer codes. CEQAs ensure the medical necessity of services, compliance with other documentation, coding and billing standards. CEQAs apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and standardized audit findings methodology to report audit results. CEQAs communicate audit results to physicians, physician leadership, senior management, Compliance department and staff. CEQAs are required to provide physician and coder education, and make recommendations to management for corrective action.  CEQAs serve as an institutional subject matters expert and resource on interpretation and application of documentation and coding rules and regulations. CEQAs assure the quality of the coding documentation fits service and codes, and any missing labels on documentation are corrected. 
 

Minimum Job Qualifications

• Licensure or other certifications: CPC and/or CCS-P Coding Certification. CPMA, CEMC or other Nationally recognized healthcare auditing certification required at hire, or required to obtain within 6 months of hire.

• Educational Requirements: High School Diploma or GED.

• Minimum Experience: Minimum of three (3) years of experience in a healthcare role involving the direct application of CPT, ICD-10-CM, and/or modifiers in coding, auditing, or documentation review. Specialized Skills & Proficiency Demonstrated ability to: Apply coding guidelines to complex, multi-specialty documentation. Identify errors, discrepancies, and compliance risks within medical records. Translate audit findings into clear, actionable feedback and process improvements. Additional Qualifications: Demonstrated experience educating providers and presenting to large audiences.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Advanced knowledge of ICD-9, ICD-10, CPT, HCPCS coding principles and medical terminology

• Strong understanding of coding policies, procedures, and regulatory/third-party requirements

• Advanced proficiency in Microsoft Office, including Excel and PowerPoint

• Ability to communicate complex coding concepts to both technical and non-technical audiences

• Strong data organization, analytical skills, and detailed reporting capabilities

• Skilled in developing and delivering presentations to diverse audiences

• Highly organized, detail-oriented, and self-motivated, with the ability to work independently and collaboratively

• Builds strong relationships across teams, maintains a positive, professional demeanor, and supports a team-oriented work environment

Essential Tasks and Responsibilities

• Coordinates and performs professional services documentation and coding audits for outpatient records (NGPG/NGHS)

• Reviews clinical documentation for completeness, accuracy, and data integrity

• Audits provider coding using ICD-10, CPT, HCPCS, and CMS guidelines

• Conducts daily audits for new, PRN, locum, and flagged providers until audit standards are met

• Reviews findings with providers and recommends documentation and coding improvements

• Trains and orients new providers on coding and documentation expectations

• Ensures charts meet compliance standards and organizational policies

• Prepares and delivers audit reports by provider and practice

• Tracks and follows up on provider improvement and compliance

• Develops and delivers coding education, training programs, and updates

• Supports denial management by reviewing CPT denials and implementing corrective actions

• Serves as a coding compliance resource, supports operational needs (claims, queues, escalations), and maintains ongoing professional development

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving