Children's National Medical Center
Coding Auditor
Children's National Medical Center, Silver Spring, Maryland, United States, 20900
Overview
The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees, including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed. Audits evaluate the adequacy and accuracy of documentation in support of services billed, including ICD-10/CPT/HCPCS and other third-party payor codes, DRG and EAPG assignments, medical necessity, reimbursement overpayments and underpayments, and compliance with documentation, coding and billing standards. The Coding Auditor applies standardized audit scoring and findings methodologies to report audit results. Responsibilities
Performs scheduled and unscheduled independent audits of professional fee documentation, coding and medical necessity for professional service providers (physicians and non-physician providers) as well as facility/technical fee audits (inpatient and outpatient). Conducts specialized and focused audits; evaluates the appropriateness and medical necessity of services billed based on supporting documentation. Evaluates the appropriateness of ICD-10, HCPCS and CPT codes, APC/EAPG, DRG, and admission assignments, including modifier usage. Assesses accuracy of supply and implant charge capture and coding per Medical Center policies and payor requirements. Determines overpayments and underpayments and performs related analyses; reports findings using standardized methodology and formats by established deadlines. Maintains knowledge of current Medicare, Medicaid and other third-party payor billing and documentation requirements. Manages audit timelines, assists with development of the audit schedule, identifies services to be audited, and ensures timely completion. Applies standardized billing audit methodology for sample selection, scoring, benchmarking, and reporting; educates staff through created materials as needed. Adheres to department productivity targets and deadlines. Other duties as assigned. Qualifications
Minimum Education : Associate's Degree. Candidates with 3 years of coding experience in lieu of the degree will be considered. Minimum Work Experience : 2 years as a Certified Coder, preferably with pediatric coding and/or experience performing coding audits within an academic medical center (Required). Required Skills/Knowledge : Interpret and apply documentation and coding rules; plan, conduct and perform coding audits; work with administrative staff and providers; manage multiple priorities; maintain up-to-date knowledge of healthcare billing and coding compliance; interpret medical records and related documentation; proficiency with Windows and Microsoft Office; communicate effectively in writing and verbally. Required Licenses and Certifications : CCS, CIC, CPC, CPC-H, or COC (Required). CPMA and/or CEMA/C or ability to acquire within 6 months after start date (Required). Functional Accountabilities
Conduct audits of professional fee documentation, coding and medical necessity for physicians and non-physician providers, and facility/technical fee billing (inpatient and outpatient) as assigned. Evaluate medical necessity and accuracy of coding, including ICD-10, CPT, HCPCS, APC/EAPG, DRG, and modifier usage. Assess charge capture and coding accuracy; identify overpayments/underpayments and document findings. Maintain audit timelines, process adherence, and standardized reporting. Educate and collaborate with clinical and administrative staff; develop educational materials as needed. Other duties as assigned. Organizational Accountabilities
Teamwork/Communication: demonstrate collaborative and respectful behavior; partner with team members to achieve goals; be receptive to others’ ideas and opinions. Performance Improvement/Problem-solving: contribute to a positive work environment; be flexible and proactive in identifying process improvements; make sound decisions. Cost Management/Financial Responsibility: use resources efficiently; seek cost-effective solutions. Safety: promote patient, family, visitor and co-worker safety; verify information for decision making; act with accuracy and timeliness. Locations & Job Details
Primary Location : Maryland-Silver Spring Work Locations : Dorchester, 12200 Plum Orchard Dr, Silver Spring 20904 Job : Non-Clinical Professional Organization : Finance Position Status: Regular - Full-Time (FT) Shift: Day Work Schedule: Monday–Friday Job Posting
Posted: Sep 15, 2025, 4:45:45 PM Full-Time Salary Range
64188.8 - 106995.2 Children's National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The Know Your Rights poster and the pay transparency poster are available here: Know Your Rights — Pay Transparency. Please note that it is the policy of Children’s National Hospital to maintain a drug-free workplace. The organization prohibits illegal use, possession or distribution of controlled substances and the misuse of legal substances by staff. Recreational or prescribed marijuana policies apply as per organizational policy.
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The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees, including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed. Audits evaluate the adequacy and accuracy of documentation in support of services billed, including ICD-10/CPT/HCPCS and other third-party payor codes, DRG and EAPG assignments, medical necessity, reimbursement overpayments and underpayments, and compliance with documentation, coding and billing standards. The Coding Auditor applies standardized audit scoring and findings methodologies to report audit results. Responsibilities
Performs scheduled and unscheduled independent audits of professional fee documentation, coding and medical necessity for professional service providers (physicians and non-physician providers) as well as facility/technical fee audits (inpatient and outpatient). Conducts specialized and focused audits; evaluates the appropriateness and medical necessity of services billed based on supporting documentation. Evaluates the appropriateness of ICD-10, HCPCS and CPT codes, APC/EAPG, DRG, and admission assignments, including modifier usage. Assesses accuracy of supply and implant charge capture and coding per Medical Center policies and payor requirements. Determines overpayments and underpayments and performs related analyses; reports findings using standardized methodology and formats by established deadlines. Maintains knowledge of current Medicare, Medicaid and other third-party payor billing and documentation requirements. Manages audit timelines, assists with development of the audit schedule, identifies services to be audited, and ensures timely completion. Applies standardized billing audit methodology for sample selection, scoring, benchmarking, and reporting; educates staff through created materials as needed. Adheres to department productivity targets and deadlines. Other duties as assigned. Qualifications
Minimum Education : Associate's Degree. Candidates with 3 years of coding experience in lieu of the degree will be considered. Minimum Work Experience : 2 years as a Certified Coder, preferably with pediatric coding and/or experience performing coding audits within an academic medical center (Required). Required Skills/Knowledge : Interpret and apply documentation and coding rules; plan, conduct and perform coding audits; work with administrative staff and providers; manage multiple priorities; maintain up-to-date knowledge of healthcare billing and coding compliance; interpret medical records and related documentation; proficiency with Windows and Microsoft Office; communicate effectively in writing and verbally. Required Licenses and Certifications : CCS, CIC, CPC, CPC-H, or COC (Required). CPMA and/or CEMA/C or ability to acquire within 6 months after start date (Required). Functional Accountabilities
Conduct audits of professional fee documentation, coding and medical necessity for physicians and non-physician providers, and facility/technical fee billing (inpatient and outpatient) as assigned. Evaluate medical necessity and accuracy of coding, including ICD-10, CPT, HCPCS, APC/EAPG, DRG, and modifier usage. Assess charge capture and coding accuracy; identify overpayments/underpayments and document findings. Maintain audit timelines, process adherence, and standardized reporting. Educate and collaborate with clinical and administrative staff; develop educational materials as needed. Other duties as assigned. Organizational Accountabilities
Teamwork/Communication: demonstrate collaborative and respectful behavior; partner with team members to achieve goals; be receptive to others’ ideas and opinions. Performance Improvement/Problem-solving: contribute to a positive work environment; be flexible and proactive in identifying process improvements; make sound decisions. Cost Management/Financial Responsibility: use resources efficiently; seek cost-effective solutions. Safety: promote patient, family, visitor and co-worker safety; verify information for decision making; act with accuracy and timeliness. Locations & Job Details
Primary Location : Maryland-Silver Spring Work Locations : Dorchester, 12200 Plum Orchard Dr, Silver Spring 20904 Job : Non-Clinical Professional Organization : Finance Position Status: Regular - Full-Time (FT) Shift: Day Work Schedule: Monday–Friday Job Posting
Posted: Sep 15, 2025, 4:45:45 PM Full-Time Salary Range
64188.8 - 106995.2 Children's National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity, or other characteristics protected by law. The Know Your Rights poster and the pay transparency poster are available here: Know Your Rights — Pay Transparency. Please note that it is the policy of Children’s National Hospital to maintain a drug-free workplace. The organization prohibits illegal use, possession or distribution of controlled substances and the misuse of legal substances by staff. Recreational or prescribed marijuana policies apply as per organizational policy.
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