Coding Compliance Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate medical records and clinical documentation to ensure coding is accurate, complete, and meets compliance standards according to CMS regulations, along with federal and state guidelines (e.g., AHIMA, CMS, Medicaid) and specific payer policies.

• Execute routine and specialized coding audits to pinpoint documentation deficiencies, coding errors, and compliance risk areas.

• Partner with clinical leadership, revenue cycle, and compliance teams to address coding discrepancies and promote accurate documentation practices.

• Relay audit results to providers and coding personnel, offering actionable, audit-defensible recommendations and focused education.

• Conduct follow-up audits to confirm remediation efforts and guarantee sustained enhancements in coding accuracy and compliance.

• Generate written reports of findings for Compliance Leadership regarding charts reviewed quarterly, metrics on coding accuracy, and identified risk areas.

• Act as a subject matter expert in pediatric, Medicaid, telehealth, and behavioral health coding, offering guidance on complex or high-risk situations.

• Interpret and implement state-specific Medicaid and payer billing requirements, maintaining expertise across various markets while ensuring adherence to regulatory and contractual guidelines; continuously research, monitor, and educate providers and coding staff regarding new payer policies, state expansions, and industry developments.

⛳️ Requirements

• Over 5 years of experience in professional fee coding and auditing, with a focus on E/M and outpatient coding in diverse clinical environments. Telehealth experience is preferred.

• Proficient in medical terminology, standard coding, and reference publications, including CPT, HCPC, ICD-10, DRG, etc.

• Previous coding or auditing experience in a Medicaid setting.

• Proven experience delivering individual and group training sessions to staff and providers, utilizing excellent verbal and written communication skills.

• Solid understanding of HEDIS measures and E/M coding, with the capability to assess documentation for quality measure compliance and audit-defensible coding practices.

• Bachelor’s degree in healthcare management or a related field is preferred.

• Familiarity with EMR software (e.g., Athena Health).

• CPC, CCS, and CPMA certifications are required.

• Strong quantitative and analytical abilities, with the skill to clearly and concisely communicate data to varied audiences.

• Exhibit a strong commitment to coding compliance and regulatory standards, while applying critical thinking and adaptability within a value-based care framework, where coding scenarios may necessitate nuanced interpretations beyond traditional fee-for-service guidelines.

🏝️ Benefits

• Competitive medical, dental, and vision insurance.

• Healthcare and Dependent Care FSA; Company-funded HSA.

• 401(k) with a 4% match, vested 100% from day one.

• Employer-paid short and long-term disability.

• Life insurance at 1x annual salary.

• 20 days of PTO plus 10 Company Holidays and 2 Floating Holidays.

• Paid new parent leave.

• Additional benefits to be outlined in the offer.