Provider Coding Auditor – Educator

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

📋 Description

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

• Assess clinician documentation to ensure accurate assignment of CPT, HCPCS, and ICD-10-CM codes, E/M level selection, and supporting medical decision-making documentation.

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

• Provide one-on-one education for providers following audits.

• Develop and deliver focused training for clinicians and coding personnel on coding standards, documentation requirements, CDI principles, and risk factors.

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

• Support clinician documentation guidelines, best practices, and reference materials.

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

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

• Assist in educating new clinicians and in ongoing efforts for coding and documentation enhancement.

• Engage in compliance and revenue integrity activities, internal assessments, payer inquiries, and audit-related projects.

• Maintain tools for tracking audits and quality metrics for reporting, analysis, and continuous improvement.

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

• Travel to physician offices and clinical locations as required for on-site audits and in-person training.

⛳️ Requirements

• High School Diploma/GED with 7 years of total 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 comparable healthcare field with 5 years of professional coding experience, also covering 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 mandatory.

• CDEO certification must be obtained within 18 months of hire.

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

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

• Capability to independently evaluate documentation and coding accuracy, recognize patterns, trends, and risk areas, and apply regulatory standards.

• Proficient in providing education to providers through individual feedback, group training, and written resources.

• Ability to work collaboratively with clinicians, compliance, revenue cycle, CDI, and leadership.

• Exhibits professionalism, discretion, confidence, and skills in relationship-building.

• High level of accuracy in reviewing medical records, audit results, and educational materials.

• Ability to manage priorities autonomously in a hybrid setting and adapt to regulatory changes.

• Willingness to travel to physician offices and clinical sites as needed.

• Employee vaccination is required for measles, mumps, rubella, varicella, and influenza, unless an approved medical or religious exemption applies.

🏝️ Benefits

• Tuition reimbursement.

• Access to in-person and online development opportunities.

• Availability of a career hub.

• Comprehensive benefits package.

• Paid holidays.

• Generous paid time off (PTO).

• Employee discounts.

• Complimentary individual retirement counseling.

• Free wellness platform for you and your family.

• Tailored support for personal or family challenges.

• Opportunities to contribute ideas through improvement huddles, employee surveys, and town hall meetings.