Job Description
Job Description – Coding and Billing Auditor
Location: Dover, DE
Schedule: Days
Job Type: Permanent/Full-Time
Salary Range: $53,000.00 to $81,000.00
Position Overview:
The Coding and Billing Auditor is responsible for reviewing, analyzing, and auditing professional physician claims to ensure accurate ICD-10 and CPT coding, complete and compliant clinical documentation, and adherence to internal and regulatory standards. This role provides guidance and education to physicians, midlevel providers, coders, and charge entry personnel to improve documentation quality and coding accuracy. The auditor also supports the revenue cycle team and collaborates with leadership to implement process improvements and training initiatives. This is a full-time, onsite position at BayHealth Hospital – Kent Campus in Dover, DE.
Key Responsibilities:
- Perform data quality reviews and audits of provider medical records to validate accuracy of ICD-10 and CPT coding, principal and secondary diagnoses, and procedures.
- Compile audit findings and produce detailed reports with analysis, ensuring that selected codes accurately reflect clinical documentation.
- Conduct annual audits of established provider records and maintain comprehensive audit logs to meet compliance and productivity standards.
- Collaborate with medical staff to validate audit findings, clarify documentation, and provide both formal and informal education on coding and documentation best practices.
- Train new coding and revenue cycle staff on coding guidelines, documentation requirements, and auditing processes.
- Assist the Revenue Cycle Manager with evaluation of coding activities, performance assessments, and process improvement initiatives.
- Perform coding functions as needed, including multi-specialty professional claims, ensuring consistency and accuracy.
- Participate in the development and implementation of tools and strategies to support provider documentation and compliance initiatives.
- Ensure all coding and auditing activities adhere to federal, state, and organizational regulations, including CPT, ICD-10, and payer-specific requirements.
Required Qualifications:
- Associate degree in a related field (Bachelor’s preferred).
- Certified Professional Coder (CPC) credential required.
- Minimum 5 years of professional physician coding experience in an office-based setting.
- Strong knowledge of CPT, ICD-10, and clinical documentation standards.
- Proven ability to audit medical records and identify coding and documentation issues.
- Excellent communication and interpersonal skills, with experience providing feedback and education to physicians and clinical staff.
Preferred Qualifications:
- Experience auditing provider records and performing coding in a multi-specialty group practice.
- Prior auditing experience within a revenue cycle or compliance function.
- Experience working directly with physicians and midlevel providers to optimize documentation and coding compliance.
Certifications & Licensing:
- CPC (Certified Professional Coder) – Required
- Familiarity with revenue cycle and coding compliance best practices
Work Environment & Physical Demands:
- Full-time, onsite position in a hospital/office-based environment.
- Ability to sit, stand, and walk for extended periods, and lift up to 35 pounds occasionally.
- Moderate exposure to office hazards, clinical documentation, and coding-related materials.
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.
Thank you!