Coding & Compliance Eye Auditor

Accountabilities: Conduct detailed medical record audits to assess documentation quality, coding accuracy, billing practices, and compliance with applicable regulatory and payer requirements.

Review clinical documentation across ophthalmology, optometry, and other medical specialties, identifying coding discrepancies, documentation gaps, reimbursement risks, and opportunities for improvement.

Interpret and apply guidance from CMS, AMA, OIG, NCCI, and other relevant regulatory bodies and payers to support accurate, defensible audit conclusions.

Access and review medical records through electronic medical record (EMR) and practice management systems, ensuring audit findings are properly documented and supported by evidence.

Prepare comprehensive audit reports, executive summaries, corrective action plans, and compliance recommendations for healthcare providers, operational leaders, attorneys, and executive stakeholders.

Communicate audit results and emerging coding or compliance trends clearly, providing practical, risk-based recommendations to improve documentation, billing accuracy, and operational performance.

Deliver provider education and training sessions on coding requirements, documentation standards, billing practices, and regulatory compliance.

Support healthcare compliance consulting engagements, due diligence projects, and client initiatives requiring specialized coding and documentation expertise.

Participate in quality assurance and peer review activities, review audit reports, and implement necessary corrections to maintain consistency, accuracy, and high-quality deliverables.

Contribute to the development and maintenance of audit tools, methodologies, educational resources, and internal compliance guidance.

Collaborate with project teams and leadership to define project objectives, assess feasibility, manage priorities, and deliver assignments within established timelines, scope, quality standards, and budgets.

Build and maintain strong relationships with clients and internal stakeholders while serving as a trusted resource on coding, documentation, and compliance matters.

Maintain up-to-date knowledge of healthcare regulations, payer policies, reimbursement principles, and emerging coding and auditing practices.

Use Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint, alongside relevant audit and reporting tools to support efficient project delivery.

Requirements:

Bring at least 5–10 years of hands-on experience in a healthcare practice setting, such as an ophthalmic technician, medical scribe, or clinic manager, with a strong understanding of clinical operations and conditions commonly encountered in ophthalmology and/or optometry; alternatively, have at least 3 years of experience in healthcare auditing, documentation review, compliance, or regulatory work.

Demonstrate experience auditing professional coding, ideally in ophthalmology, optometry, or multiple specialties and healthcare service settings.

Possess strong knowledge of CPT, HCPCS, and ICD-10 coding systems, physician documentation requirements, evaluation and management (E/M) coding, healthcare reimbursement principles, and applicable CMS guidelines.

Understand healthcare regulatory requirements, payer policies, medical coding and billing compliance, and HIPAA privacy and confidentiality standards.

Be capable of analyzing complex documentation scenarios, interpreting regulatory guidance, identifying risk patterns, and translating findings into clear, defensible conclusions and actionable recommendations.

Have experience preparing written audit reports, developing corrective action plans, and presenting findings to providers, executives, compliance leaders, or other professional stakeholders.

Demonstrate strong written and verbal communication skills, including the ability to explain technical coding and compliance matters clearly and facilitate effective provider education.

Possess excellent analytical, critical-thinking, problem-solving, organizational, and time-management skills, with a high level of attention to detail and commitment to quality.

Be comfortable working independently in a consulting or client-service environment, managing multiple priorities, meeting deadlines, and maintaining productivity in a fully remote setting.

Demonstrate professionalism, adaptability, sound judgment, and a collaborative approach to resolving complex coding and billing questions with colleagues and clients.

Be proficient with technology and internet-based tools, including Microsoft Office applications, and able to work effectively with electronic medical record and practice management systems.

Hold a relevant certification such as JCAHPO credentials (COA, COT, or COMT), CPC, CPMA, OCS, or COPC, or be willing to obtain appropriate coding certification(s). Ophthalmic coding expertise and the COE credential are considered valuable assets.

Be willing to undertake some travel as required by client engagements.

Additional preferred certifications include CPMA, CHC, CPCO, CRC, RHIA, RHIT, and COC.

Benefits:

Fully remote working arrangement, offering flexibility to work from India.

Opportunity to contribute to meaningful healthcare compliance, coding accuracy, and documentation quality initiatives across a diverse client portfolio.

Exposure to a broad range of healthcare organizations, including physician practices, hospitals, health systems, academic medical centers, law firms, and private equity organizations.

Opportunities to expand specialized expertise in ophthalmology and optometry coding, healthcare auditing, regulatory compliance, and reimbursement practices.

Professional development through collaboration with experienced healthcare auditing and compliance professionals.

Opportunities to contribute to provider education, quality improvement, and the development of audit methodologies and compliance resources.

Salary and additional benefits: Compensation, healthcare coverage, paid leave, certification support, and other employment benefits have not been specified in the available job description and should be confirmed during the hiring process.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

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