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Healthcare Compliance
Statistical Sampling & Coding Audit Services

Medical Coding Audits

Coding Audit Services

SunHawk’s team of certified medical coding and audit experts possess knowledge across a wide range of specialties and have assisted dozens of organizations in improving their medical coding programs. Additionally, SunHawk Professionals have decades of experience preparing for and responding to external medical coding audits conducted by government agencies or health insurers.

How We Can Help:  

  • Medical Coding / Documentation Audits: We assess whether a provider’s level of service is supported by coding guidelines, specify recommendations to improve accuracy and compliance, and provide feedback on potentially high-risk documentation concerns.
  • RAC & External Audits: We provide end-to-end support to ensure your organization is well-prepared for RAC and other external audits. Our team of experts will help you identify potential vulnerabilities, implement proactive measures, and effectively respond to audit inquiries. We ensure your positions and your needs on complex issues and subjects are clearly communicated to government regulators and enforcement personnel.


Provider & Staff Coding Education

Increasing physician coding proficiency can materially impact your organization’s bottom line and lower your regulatory risk. SunHawk’s education program takes a holistic approach to help any team boost its knowledge and improve and/or reinforce coding competency.  We work with a wide range of entities, including major hospital groups, SNFs, Cancer Centers, dental practices, as well as small, independently owned physician practices.


Credential and Licenses Held by Our Experts Include:

  • Certified coders (CPC, CCS, RHIA, RHIT, etc.)
  • Certified Risk Adjustment Coder (CRC)
  • Advanced Hierarchical Condition Category Associates (AHCCA)
  • Healthcare Anti-Fraud Associates (HCAFA)
  • Licensed Nurses and Nurse/Coders
  • Licensed Physicians

Illustrative Projects and Assignments:

  • Medical coding reviews: both inpatient and outpatient settings
  • Medical coding and documentation audits
  • Clinical documentation improvement reviews
  • Documentation of Medical Necessity Interventions
  • Quarterly coding quality control reviews
  • Review of coding related to issues of fraud, waste, or abuse (FWA)
  • Development of risk adjustment and coding policies
  • Responding to law enforcement reviews and findings related to medical coding
  • Risk Adjustment coding
  • Educating coders and clinicians on risk adjustment coding requirements and standards
  • Statistical overpayment estimation and reporting
  • Quarterly monitoring of claims and billing quality


"SunHawk demonstrated a commendable commitment to precision and compliance throughout our engagement. Their expertise in navigating complex healthcare regulations was evident, providing us with a thorough and insightful audit. We required assistance with a complex billing audit that required statistical analysis. As a smaller healthcare system, SunHawk provided us a level of audit expertise that we are not able to staff in-house. The team’s responsiveness and industry knowledge make them a valuable partner for healthcare organizations seeking rigorous and reliable auditing services."

Sara Coverstone

Chief Compliance & Privacy Officer
Northern Arizona Healthcare

"SunHawk was an outstanding partner in the provision of interim leadership in compliance and internal audit for our organization.  They provided seamless coverage and advancement of our compliance and internal audit functions.  As CEO, I had no concerns or worries during our engagement.  They were true partners for us!"

Alfred E. Pilong

President and CEO
Garnet Health

"James and the SunHawk team have been an invaluable resource for our Compliance Office - they are a reliable, well experienced, trusted and knowledgeable team of professionals who at a moment’s notice will take your calls or respond to your emails.

Their advice helped us navigate the ever evolving, highly regulated healthcare industry!  Whether it’s discussing report methodology or determining appropriate repayment, SunHawk provides the reassurance and confidence that you are doing the right thing!

We are honored to have partnered with SunHawk and will continue to do so in the future!"

Natasha Cogdill

Vice President/Chief Ethics, Compliance and Privacy Officer
Community Health System

"SunHawk’s professionals are leaders in the compliance and risk industries. Over the years I have worked with a number of their professionals on a series of projects/issues and learned SunHawk’s professionals are problem/solution-oriented and great coalition builders. 

SunHawk Professionals get the job done and are a pleasure to work with. Commitment, Experience, Professionalism, and Integrity; that's what SunHawk Professionals brings to the table."

Gerry Roy

Vice President/Chief Ethics, Compliance and Privacy Officer
Phoenix Children's Hospital

"Jim Rough is among the most conscientious professionals I have encountered. When he says he is going to do something -- he does it. Jim has a broad range of experience gained over decades in leading organizations.

Now as the founder of his own firm, Jim will be enabled to provide the same high-quality service to his clients in a setting that allows greater customization to his clients' financial circumstances."

Frank M. Placenti

Chair, US Corporate Governance & Securities Regulation
Practice, Squire Patton Boggs

"SunHawk Consulting's HIPAA Check Program provided us with an invaluable third-party review of our HIPAA policies and practices. The tracking tool SunHawk includes with the Program has become an integral part of our continued monitoring for HIPAA compliance.

Jan Elezian's extensive hands-on compliance experience was evident during site visits and staff interviews as she translated difficult subject matter into practical use scenarios and provided quality feedback. Thank you SunHawk team!"

Nancy Lipman

Vice President, Compliance
Chicanos Por La Causa, Inc.

"SunHawk provides an array of dynamic professionals, each with significant subject matter expertise and a problem-solver approach. Beyond their knowledge and conscientious work ethic, however, is a team of caring individuals who strive to furnish individualized, tailored assistance with a personal touch. 

Jim Rough's dedication to the success of SunHawk clients is evidenced by his strategic and prospective thinking complemented by his ability to truly anticipate the needs of a company in the midst of the complicated compliance climate. I highly recommend SunHawk for companies of any size seeking actionable solutions and measurable results."

Michelle Missal

Vice President and Chief Compliance Officer
Paragon 28, Inc.

“Sunhawk Consulting has proven to be a trusted partner with the ability to deliver results. We have consistently been impressed with their expertise, professionalism, and commitment to customer service.  Sunhawk Consulting has supported our enterprise-wide risk assessment, risk management activities, and the configuration of our Governance, Risk and Compliance software tool.

Sunhawk Consulting’s leadership and consultative services have helped us to successfully navigate through the complexities of SOC, HIPAA, NIST and FedRAMP audits this year.  The knowledgeable team of Sunhawk professionals has been and continues to be an invaluable resource for us, ensuring we are positioned for success in all our audits and assessment activities.”

Zachary Fain

Chief Technology Officer (CTO)
Signature Performance

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SunHawk Consulting

2550 E Rose Garden Ln.
Unit 72016
Phoenix, AZ 85050

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