Lead Healthcare Coding Quality Auditor

🔥 14 hours ago

🌐 Egypt, United States – Remote

🇪🇬 Egypt – Remote 🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔎 Auditor

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sutherland

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1986

🏥 Healthcare

🛡️ Insurance

✈️ Travel

💰 $300M Secondary Market on 2014-10

Healthcare • Insurance • Travel

Sutherland is a global company specializing in digital transformation and business process outsourcing services. They leverage advanced technologies such as Artificial Intelligence, automation, and cloud engineering to drive digital performance and optimize critical business operations. Sutherland offers a variety of services including digital CX, enterprise technology solutions, and intelligent automation across multiple industries such as banking, healthcare, and telecommunications. Their focus is on delivering measurable outcomes, enhancing customer experiences, and enabling business agility through innovative digital solutions.

📋 Description

• Perform retrospective, concurrent, and prospective coding audits for inpatient, outpatient, physician, and specialty services • Review medical documentation to validate diagnosis and procedure code accuracy and completeness • Ensure compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Medicare, Medicaid, commercial payer, and regulatory guidelines • Identify coding errors, documentation gaps, and reimbursement opportunities • Prepare audit reports with findings, trends, recommendations, and corrective actions • Provide individual and group education to coders, providers, and clinical staff • Monitor coding quality metrics and develop action plans to improve accuracy and consistency • Stay current on coding regulations, CMS regulations, payer policies, and industry best practices • Assist with internal and external audits, payer reviews, and regulatory investigations • Participate in policy development, process improvement initiatives, and coding education programs • Track audit results and identify recurring trends for continuous quality improvement

🎯 Requirements

• Minimum of 3–5 years of medical coding experience in a healthcare setting • Minimum of 2 years of coding audit or quality review experience preferred • Current coding certification such as CPC, CPMA, CCS, or CIC • RHIT or RHIA preferred • Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding systems • Strong understanding of CMS regulations, NCCI, Official Coding Guidelines, and payer-specific policies • Experience with electronic health records and encoder software • Knowledge of healthcare reimbursement methodologies • Ability to interpret complex clinical documentation • Proficiency with Microsoft Office Suite and coding/audit software • Exceptional analytical and critical thinking skills • Excellent written and verbal communication skills • Strong attention to detail and organizational abilities • Ability to maintain objectivity while providing constructive feedback • Ability to work independently and collaboratively in a fast-paced environment • Ability to maintain confidentiality of PHI in accordance with HIPAA regulations

🏖️ Benefits

• Full-time employment • Confidential handling of employee information according to EEO guidelines • Equal employment opportunity protections • Voluntary Administrative EEO record disclosure; participation does not affect employment decisions