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Outpatient Coding Auditor Category: Analytics and Emerging Digital Technologies
Main location: United States, Georgia, Atlanta
Alternate Location(s): United States, North Carolina, Charlotte
United States, Tennessee, Knoxville
United States, Texas, Dallas
Position ID:J1026-1136
Employment Type: Full Time
Position Description: CGI is seeking an experienced Outpatient Coding Auditor to join our Healthcare Compliance Audit Team. In this role, you will leverage your outpatient coding, clinical documentation, and reimbursement expertise to conduct comprehensive medical record audits and identify potential improper payments, including overpayments and underpayments. You will review claims across outpatient hospitals, ambulatory surgical centers, physician practices, and other healthcare settings, delivering accurate, well-supported, and thoroughly documented audit findings.
This is a fully remote position open to candidates located anywhere in the United States. Candidates must be available to work Eastern Time Zone business hours. The ideal candidate is a self-motivated, detail-oriented professional with strong analytical, critical thinking, and written communication skills who thrives in an independent, collaborative environment. CGI provides ongoing training and professional development to support evolving audit methodologies, regulatory requirements, and industry standards.
Your future duties and responsibilities:• Conduct detailed medical record reviews to identify coding discrepancies, reimbursement inaccuracies, and potential payment recovery opportunities across outpatient facility, professional, and allied health claims
• Evaluate clinical documentation, coding accuracy, and reimbursement methodologies to determine compliance with applicable coding standards, payer policies, and regulatory requirements
• Develop clear, comprehensive audit findings and written rationales supported by authoritative coding references, clinical documentation, and reimbursement guidelines
• Apply ICD-10-CM, CPT, HCPCS, National Correct Coding Initiative (NCCI) edits, Outpatient Code Editor (OCE) edits, and other applicable coding and payment methodologies to support accurate audit determinations
• Interpret and apply CPT Assistant, Coding Clinic for HCPCS, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and client-specific reimbursement and medical policies
• Collaborate with the Edit Development team to provide feedback on claims selection criteria, emerging coding trends, and new payment recovery concepts
• Maintain established audit quality, productivity, accuracy, and documentation standards while meeting client requirements and contractual deliverables
• Communicate audit findings, coding interpretations, and recommendations effectively with team leads, internal stakeholders, and healthcare providers when applicable
• Adapt to evolving audit priorities, regulatory changes, and client requirements while maintaining compliance with CGI policies, procedures, and operational expectations
• Participate in ongoing training, professional development, and occasional onsite provider reviews or other business-related travel as required
Required qualifications to be successful in this role:• Current professional coding certification through AHIMA or AAPC, such as RHIT, RHIA, CCS-P, CPC, or COC (formerly CPC-H)
• Minimum of five years of outpatient surgical coding experience in a facility and/or professional healthcare setting
• Extensive knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including appropriate modifier usage, coding conventions, and documentation requirements
• Working knowledge of the Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classifications (APCs), NCCI edits, and OCE edits
• Demonstrated ability to analyze complex medical records, interpret clinical documentation, and identify coding or reimbursement discrepancies
• Strong critical thinking, analytical, and problem-solving skills with the ability to make independent, evidence-based audit determinations
• Excellent written communication skills, including the ability to develop clear, accurate, and well-reasoned audit narratives with appropriate supporting references
• Experience using coding encoders, electronic medical records, and remote medical record review systems
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel, and familiarity with Windows-based operating systems
• Strong organizational and time-management skills, with the ability to work independently, adapt to changing priorities, and consistently meet established quality and productivity standards
Desired qualifications / Strongly Preferred
• Outpatient surgical coding experience in specialty areas such as orthopedics, cardiology, spine and back procedures, and interventional radiology
• Previous experience conducting coding audits, peer reviews, payment integrity reviews, or healthcare reimbursement compliance assessments
• Experience training, mentoring, or providing quality feedback to junior-level coders or coding professionals
• Familiarity with Charge Description Master (CDM) structures, maintenance, and reimbursement implications
• Experience using TruCode encoder software and other advanced coding or audit applications
• Experience supporting healthcare payer audits, recovery initiatives, or complex outpatient claims reviews
Other Information:
CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $70,800.00 $123,800.00.
CGI's benefits are offered to eligible professionals on their first day of employment to include:
. Competitive compensation
. Comprehensive insurance options
. Matching contributions through the 401(k) plan and the share purchase plan
. Paid time off for vacation, holidays, and sick time
. Paid parental leave
.Learning opportunities and tuition assistance
. Wellness and Well being programs
CGI Federal anticipates accepting applications for this position through 2026 12 31.
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Skills: - Communication
- Compliance
- CPT Coding
- Health Care Payers
- MS Office365
- Technical Auditing
