QUALITY • AUDIT • CONTINUOUS IMPROVEMENT
 

What Makes a Great Coding & Auditing Team?

 
Michele Logue headshot
Michele Logue, CCS, RHIT, CDIP
 
Director of Coding Operations
 
e4health
 

As coding and auditing professionals, success is not defined by productivity or accuracy alone. Those metrics matter, but a high-performing team also demonstrates strong judgment, consistency, communication, and the ability to turn findings into measurable improvement.

 
1

Accountability: Owning the Quality of the Record

Accountability means understanding the rationale behind coding decisions, recognizing when documentation or guidance does not support an assumption, and knowing when clarification or escalation is needed.

Coders and auditors should be able to support decisions with authoritative guidance and apply that guidance consistently.

In practice
Use authoritative resources to support decisions.
Escalate unclear or conflicting guidance.
Understand the rationale behind audit findings.
Track recurring errors and address identified trends.
 
2

Collaboration: Creating Consistency

Coding and auditing should function as complementary disciplines. When disagreements occur, the goal should be to determine the most defensible and compliant outcome—not simply who is “right.”

Questions, audit findings, and difficult cases should become opportunities to improve consistency across the team.

Key actions
Identify recurring disagreements or inconsistent interpretations.
Review overturn trends and successful appeals.
Use findings to drive focused education or clarification.
Re-measure performance to determine whether improvement occurred.
 
3

Moving From Findings to Root Cause

A strong quality program does not stop at identifying an error. We should also ask why the error occurred.

Recurring findings may result from a knowledge gap, unclear documentation, inconsistent interpretation, outdated resources, or workflow issues. Understanding the root cause helps ensure we are solving the right problem.

The Quality Loop
Finding Trend Root Cause Intervention Re-measurement
For recurring trends, ask
?
Is the issue isolated or systemic?
?
What is the root cause?
?
What action is needed?
?
Did the action result in sustained improvement?
 
4

Adaptability and Continuous Learning

Coding and auditing continue to evolve through new guidance, regulatory changes, payer policies, and audit findings. Staying current and applying new information consistently are essential to maintaining quality.

Education should also be connected to measurable outcomes. Rather than measuring completion alone, we should evaluate whether it changed performance.

Meaningful measures can include
Overall and category-specific accuracy.
Repeat error and audit overturn rates.
First-pass accuracy.
Pre- and post-education performance.
Reduction in repeat findings over time.
 

Turning Expectations Into Action

Our ongoing focus should be simple:

Identify trends, not just errors.
Validate decisions with authoritative guidance.
Use findings to drive focused education.
Measure whether interventions work.
Share knowledge to improve consistency.
 

A high-performing coding and auditing team does more than meet a metric. It uses quality data to understand performance, identify risk, and continuously improve.

 

The question should not only be “Did we meet the metric?”

Key Takeaway

It should also be: “What are our findings telling us, what are we doing about them, and did it make a measurable difference?”