Professional Coding Quality Auditor

Job Title: Quality Officer

Location: System Business Office

Department Name: HIM - Professional

Req #: 0000207757

Status: Salaried

Shift: Day

Pay Range: $62,476.00 - $88,248.00 per year

Pay Transparency:

The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Job Summary

The Professional Coding Quality Auditor is responsible for reviewing professional fee medical records to ensure accurate, complete, and compliant coding in accordance with federal and state regulations, payer guidelines, and internal RWJBH policies. This role supports the integrity of professional outpatient and inpatient coding practices by applying current coding standards and regulatory guidance. The Auditor collaborates with providers, coding teams, and compliance staff to promote consistent, high-quality documentation and coding across the RWJBH system.

Under the direction of the System Professional Coding Quality and Review Manager, the Auditor contributes to enterprise-wide initiatives such as Heat Map reviews, Joint Venture audits, and Corporate Compliance reviews. The ideal candidate demonstrates strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems, with a focus on Evaluation and Management (E/M) services, and is committed to continuous learning and regulatory awareness.

Essential Functions:

• Reviews professional fee medical records to assess the accuracy and completeness of CPT, ICD-10-CM, and HCPCS code assignment, including modifiers and units, in accordance with applicable coding guidelines and payer-specific requirements.
• Ensures that professional outpatient and inpatient coding practices align with federal and state regulations, payer policies, and internal RWJBH standards.
• Documents findings in a clear, concise format and communicates results to the System Professional Coding Quality and Review Manager for further action or education.
• Supports the execution of the annual Physician Review Work Plan, including Heat Map reviews, by completing assigned provider reviews and tracking progress in designated systems.
• Participates in Joint Venture (IPA) coding reviews and Corporate Compliance-directed reviews, as assigned.
• Researches official coding guidance (e.g., CPT Assistant, AHA Coding Clinic, CMS publications) to support audit findings and respond to coding inquiries.
• Applies current Evaluation and Management (E/M) guidelines, including split/shared, incident-to, and teaching physician rules, to ensure compliant documentation and code selection.
• Collaborates with the Professional Coding Provider Education team to share findings that may inform future education initiatives.
• Maintains up-to-date knowledge of CMS guidelines, OIG Work Plan items, and payer-specific policies; contributes to maintaining a shared repository of regulatory references.
• Assists in identifying trends, recurring issues, or potential risk areas in provider documentation and coding practices.
• Prepares and maintains accurate records of review activities, including audit summaries and tracking logs.
• Escalates complex or high-risk findings to the System Professional Coding Quality and Review Manager for further review or compliance referral.
• Responds to coding-related inquiries and provides evidence-based recommendations supported by official guidance.
• Performs other duties as assigned.

Job Requirements:

• CPC or COC certification is required. CPMA is preferred; however, candidates who do not currently hold the CPMA credential will be expected to obtain it within six months of hire; credentials must be maintained for continued employment.

• Associate's degree or equivalent experience required.
• Minimum 3 years of professional coding experience, including E/M coding.
• Prior experience conducting coding audits required.
• Strong understanding of CPT, ICD-10-CM, and HCPCS coding systems.
• Familiarity with federal and state coding regulations, including NCDs, LCDs, and payer-specific guidelines.
• Ability to interpret and apply official coding guidance (e.g., CPT Assistant, Coding Clinic, CMS manuals).
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) required.
• Experience with coding software platforms (e.g., 3M, EncoderPro, Epic) preferred.
• Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered,

high-quality academic medicine in a compassionate and equitable manner, while delivering

a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer