About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Roles and Responsibilities: Auditing and reviewing medical documentation for appropriate ICD and CPT coding and ensuring that codes tally with doctors’ diagnosis. Asking explanation from physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes Ensuring compliance with medical coding policies and guidelines. Be updated about new coding rules as codes change from time to time. Collecting and distributing coding related information and billing issues. Exceptional Knowledge of medical terminology, anatomy, physiology, disease processes, and pharmacology. Work as part of a team and achieve the team quality and productivity standards. Required Expertise & Qualification: Life Science graduation or any equivalent graduation with Anatomy/Physiology as main subjects 3 to 5 years of work experience as a medical coder. Any one of the following coding certifications CPC, COC, CRC, CPCP from AAPC CCS, CCSP, CCA from AHIMA Proficient computer skills. Excellent communication skills, both verbal and written. Strong people skills & Outstanding organizational skills. Ability to maintain the confidentiality of information. An Evaluation and Management (E/M) IP & OP Auditor is a senior-level medical coding professional responsible for ensuring that physician documentation and code selection for Inpatient (IP) and Outpatient (OP) encounters are accurate, compliant, and supported by clinical evidence. Following the major E/M guideline overhauls in 2021 (Outpatient) and 2023 (Inpatient/Observation), this role focuses heavily on auditing Medical Decision Making (MDM) and Total Time to protect the organization from compliance risks and revenue loss. 1. Job Summary The E/M Auditor reviews medical records across various settings—including hospitals, clinics, and emergency departments—to validate the level of service billed.[1] They serve as a bridge between the coding team and healthcare providers, identifying documentation gaps and providing data-driven education to improve coding accuracy. 2. Core Responsibilities Audit Performance (Inpatient & Outpatient) IP Focus: Audit hospital admissions, daily progress notes, and discharge services (99221–99239). Validate that the complexity of the patient's condition justifies the level of care in an acute setting. OP Focus: Audit office visits (99202–99215) and Emergency Department (ED) visits (99281–99285), ensuring code selection aligns with the 2021/2023 MDM or Time-based rules. Pre-billing & Post-billing Audits: Conduct "shadow audits" before claims are submitted (pre-bill) to prevent denials, and retrospective audits (post-bill) to assess long-term compliance. MDM & Time Validation: Scrutinize the "Amount and Complexity of Data Reviewed," "Number and Complexity of Problems Addressed," and "Risk" to ensure the MDM table is applied correctly. Provider Education & Feedback Documentation Improvement: Identify "cloning" (copy-pasting), lack of specificity in the plan of care, or insufficient time documentation. One-on-One Education: Meet with physicians and Mid-Level Providers (PAs/NPs) to explain audit findings and provide corrective guidance. Reporting: Create detailed audit spreadsheets and executive summaries showing accuracy rates, financial impact, and trend analysis. Compliance & Regulation Guideline Mastery: Stay current with CMS, AMA, and OIG updates. Edit Review: Check for National Correct Coding Initiative (NCCI) edits and ensure appropriate use of modifiers (e.g., Modifier 25 or 57). 3. Required Qualifications & Skills Technical Skills Code Sets: Mastery of ICD-10-CM, CPT, and HCPCS Level II. Guidelines: Expert knowledge of the 1995/1997 E/M guidelines (where still applicable) and the 2021/2023/2024 E/M updates. Software: Proficiency in Electronic Health Records (EHR) like Epic, Cerner, or Meditech, and auditing software (e.g., 3M, RevPoint). Education & Experience Education: Any graduation from medical coding. Experience: Usually 3–5+ years of active E/M coding experience, with at least 1–2 years specifically in an auditing or quality review capacity. Mandatory Certifications CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist – Physician-based). CPMA (Certified Professional Medical Auditor) – Highly preferred or required within 6 months of hire. Optional: CIC (Certified Inpatient Coder) or CCS for facility-side auditing. 4. Key Performance Indicators (KPIs) Accuracy Rate: Maintaining a minimum 95% accuracy rate for audited charts. Audit Volume: Meeting weekly/monthly quotas (e.g., auditing 30-50 charts per week). Denial Reduction: Measurable decrease in E/M-related claim denials after provider education sessions. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. CorroHealth sits at the center of the revenue cycle revolution. Fundamental operations of the revenue cycle are supported through our expert teams while we recast the role of clinicians through automation. This shift to a true clinical revenue cycle helps us achieve our core purpose – exceed client financial health goals. For each patient population, CorroHealth automates key clinical aspects of the cycle. Our platforms focus on capture and application of clinical documentation while easing the burden on physicians. Scalability is prioritized in the support of client program operations. As with most revenue cycle partners, our skilled and enthusiastic team is available to outsource any portion of the cycle. However, we can also complement client programs with additional expert support or upskill existing client teams to meet program demands. Whether our team is deployed directly, or automation is incorporated for a more programmatic solution, CorroHealth delivers. CorroHealth has acquired Xtend Healthcare! For more information, please visit https://corrohealth.com. Applicants will only receive job-related emails from the domain @corrohealth.com. Additionally, it is important to emphasize that CorroHealth will never ask for money in return for a job offer.

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