Coding Quality Reviewer – Educator

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

📋 Description

• Conduct both prospective and retrospective audits of professional coding and medical records.

• Ensure the accuracy and completeness of ICD-10-CM, CPT, HCPCS, and modifier assignments.

• Assess clinical documentation to confirm that billed services are medically necessary, supported, and compliant.

• Verify codes assigned by coders and providers, documenting findings, variances, and justifications.

• Implement non-leading, compliant review methodologies in accordance with ACDIS/AHIMA guidelines.

• Identify underlying causes of discrepancies in coding and documentation, collaborating with leadership on corrective actions.

• Design and deliver focused educational sessions for coders, providers, and clinical departments.

• Monitor and analyze audit results to pinpoint systemic risks and opportunities for process enhancement.

• Investigate coding and documentation guidelines and compile this information into an accessible manual.

• Keep updated on coding revisions, certification prerequisites, and relevant expertise.

• Engage in compliance initiatives aimed at minimizing coding-related denials and audit discrepancies.

• Adhere to compliance with CMS, NCCI, MAC guidance, payer policies, HIPAA, privacy and security protocols, and ethical coding standards.

• Achieve or surpass a 95% coding accuracy rate and meet productivity targets.

• Audit assigned accounts, address inquiries, and provide educational support.

• Operate independently with minimal oversight as a subject matter expert.

• Attend scheduled virtual meetings and maintain effective communication through email and messaging platforms.

⛳️ Requirements

• High school diploma or equivalent is required.

• One or more of the following certifications is necessary: CPC (Certified Professional Coder) – AAPC; CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA.

• If applicable, a specialty certification in the assigned area must be obtained within one (1) year of hire.

• A minimum of five (5) years of professional coding experience is required, preferably in a large academic or multispecialty environment.

• In-depth knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines is essential.

• Familiarity with E/M coding and/or surgical/procedural coding is advantageous.

• Understanding of medical terminology, anatomy, and healthcare documentation is required.

• Knowledge of billing requirements for teaching physician, split/shared visits, and incident-to services is necessary.

• Ability to interpret complex medical documentation and accurately apply coding guidelines.

• Capability to identify trends, analyze audit data, and suggest process improvements.

• Proficiency in researching and applying regulatory guidance from CMS, MAC, and commercial payers.

• Experience with electronic health records; familiarity with Epic is preferred.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

• Strong attention to detail and excellent organizational skills are essential.

• Outstanding written and verbal communication skills are required.

• Must maintain a secure and private workspace to safeguard PHI.

• Required to utilize organization-approved secure systems (VPN, multi-factor authentication).

• Ability to meet deadlines while maintaining productivity and accuracy standards.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Retirement savings plan with employer contributions.

• Generous paid time off and flexible scheduling options.

• Opportunities for professional development and continuing education.