Provider Coding Auditor, Educator

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

📋 Description

• Conduct independent audits for professional fee coding and documentation for physicians and advanced practice providers, encompassing E/M, procedural, and diagnosis coding.

• Assess clinician documentation for the correct assignment of CPT, HCPCS, and ICD‑10‑CM codes, including the selection of E/M levels and supporting documentation for medical decision-making.

• Compile written audit findings and recommendations that highlight errors, trends, risks, and opportunities for documentation enhancement.

• Provide one-on-one educational sessions for providers following audits.

• Create and deliver focused educational programs for clinicians and coding personnel on coding standards, documentation prerequisites, CDI principles, and risk factors.

• Identify gaps in CDI that impact accuracy, medical necessity, and defensibility, while contributing to improvement initiatives.

• Assist in the development and upkeep of clinician documentation guidelines, best practices, and reference resources.

• Track coding and documentation trends, audit results, and denial causes; communicate findings to leadership and stakeholders.

• Work in partnership with coding, CDI, compliance, revenue integrity, and clinical leadership on documentation quality, audit preparedness, denial avoidance, and organizational projects.

• Aid in the education of new clinicians regarding documentation and coding practices.

• Engage in compliance and revenue integrity activities, internal assessments, payer inquiries, and initiatives related to audits.

• Maintain tools for audit tracking and quality metrics for reporting, trending, and ongoing improvement.

• Offer refresher training on coding and documentation updates as well as regulatory changes.

• Travel to physician offices and clinical locations as required for on-site audits and face-to-face education.

⛳️ Requirements

• High School Diploma/GED with 7 years of cumulative experience in professional coding, including E/M and procedural coding across various specialties, with a minimum of 2 years in professional coding audits, provider education, compliance reviews, and/or CDI; or an Associate's Degree in Health Information Management or a related healthcare field with 5 years of cumulative experience in professional coding, including E/M and procedural coding across multiple specialties, with at least 2 years in professional coding audits, provider education, compliance reviews, and/or CDI.

• CPC or CCS-P certification is required.

• Must obtain CDEO certification within 18 months of hire.

• Advanced knowledge of CPT, ICD‑10‑CM, HCPCS, and E/M coding guidelines, including payer-specific and regulatory stipulations.

• Strong grasp of outpatient/physician CDI principles, encompassing documentation specificity, medical necessity, clinical decision-making, and accurate representation of patient complexity.

• Capability to independently evaluate clinician documentation and coding accuracy, identify patterns, trends, and risk factors, and apply regulatory standards effectively.

• Proficient in delivering education to physicians and advanced practice providers through individual feedback, group training, and written guidance.

• Ability to collaborate effectively with clinicians, compliance teams, revenue cycle, CDI, and leadership.

• High level of accuracy in reviewing medical records, audit findings, and educational resources.

• Skill in managing priorities independently within a hybrid work environment while balancing remote and on-site responsibilities.

• Must comply with Munson Healthcare vaccination requirements or possess approved exemptions.

🏝️ Benefits

• Tuition reimbursement.

• Development opportunities available both in-person and online.

• Access to a career hub.

• Comprehensive benefits package.

• Paid holidays.

• Generous paid time off (PTO).

• Employee discounts.

• Complimentary individual retirement counseling.

• Free wellness platform available for you and your family.

• Personalized support for personal or family challenges.

• Opportunities to contribute ideas and influence workplace improvements through huddles, employee surveys, and town hall meetings.