Outpatient Coding Auditor - Surgical Specialty

Description:

Sage Clinical RCM, LLC is seeking an experienced Outpatient Coding Auditor with a strong background in surgical coding. This role is responsible for auditing outpatient surgical encounters to ensure accurate code assignment, compliance with regulatory guidelines, and adherence to payer and client requirements. The ideal candidate has hands-on experience auditing complex outpatient surgical cases and providing clear, constructive feedback to coding staff.

Key Responsibilities

• Perform audits of outpatient surgical encounters, including operative reports and related documentation
• Validate accurate assignment of CPT, ICD-10-CM, modifiers, and applicable APCs
• Ensure compliance with CMS, payer, and official coding guidelines
• Identify trends, risks, and educational opportunities based on audit findings
• Provide written audit feedback and coding education to support quality improvement
• Collaborate with coding leadership and quality teams to address identified issues
• Maintain required productivity, accuracy, and turnaround standards

Requirements:

Required Qualifications

• 3+ years of outpatient coding audit experience with a focus on surgical specialties
• Strong knowledge of CPT (Surgery section), ICD-10-CM, and modifier usage
• Experience auditing operative reports and post-operative documentation
• Familiarity with CMS guidelines, NCCI edits, and payer-specific rules
• Ability to clearly document audit findings and recommendations
• High attention to detail and strong analytical skills

Preferred

• Experience auditing high-volume surgical specialties such as orthopedics, general surgery, ENT, GI, or OB/GYN
• Prior experience supporting internal or external audits, quality initiatives, or education programs
• Familiarity with Epic, 3M, Optum, TruCode, or similar coding tools
• CPC, CCS, or equivalent credential (active and in good standing)