Senior Coding Quality Auditor

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Report to the Lead of the Compliance Department and collaborate directly with the Revenue Cycle Management team.

• Ensure compliance in coding and accuracy in claim submissions.

• Serve as a key resource for coding research and accuracy, providing explanations for the rationale and authoritative sources behind coding decisions.

• Function as the coding subject matter expert for Tribal Care programs, as well as new services or business lines.

• Investigate complex and new ICD-10-CM, CPT, HCPCS, and modifier inquiries.

• Keep track of code set updates, CMS changes, and payer policy modifications, and communicate relevant guidance to coders.

• Research and validate coding, documentation, and reimbursement prerequisites for Tribal Care offerings, specialty programs, state expansions, and tribal healthcare operations.

• Offer implementation guidance to coding, billing, and operational teams.

• Collaborate with leadership in Revenue Cycle, Compliance, and Operations on payer arrangements, encounter reporting, alternative payment models, and frameworks for tribal healthcare reimbursement.

• Maintain a comprehensive coding reference library.

• Carry out prospective and retrospective coding audits, monitor coder accuracy, and identify trends in errors.

• Review audit results, assist in corrective action plans and re-audits, and analyze coding-related denials to identify root causes.

• Assist with responses to external audits.

• Engage in implementation and expansion projects, creating coding workflows, educational materials, and documentation standards.

• Promote compliance, integrity, and confidentiality in line with HIPAA and 42 CFR Part 2.

• Perform additional duties as assigned.

⛳️ Requirements

• Associate degree in Health Information Management or a related field, or equivalent experience; a bachelor’s degree is preferred.

• An active coding credential is required; CPMA is preferred.

• At least 5 years of coding experience, including a minimum of 2 years in coding audits or quality reviews.

• Expert knowledge of official outpatient coding guidelines, NCCI, E/M rules, and outpatient payment methodologies.

• Strong research and auditing abilities, with the capability to document authoritative sources.

• Clear and tactful communication skills, with experience in training or leading coding staff.

• Preferred knowledge of tribal healthcare reimbursement, encounter reporting requirements, and alternative payment models.

• Expected working hours are from 8:00 am to 5:00 pm.

• Willingness to travel approximately 25% to Indigenous Pact work sites and clinic locations as necessary.

• Capacity to operate in accordance with HIPAA and 42 CFR Part 2.

• Interest or proven experience working closely with Indian Country and Tribal communities.

🏝️ Benefits

• PTO including vacation, wellness, and 11+ company-paid holidays.

• 401(k) plan.

• Medical insurance coverage.

• Dental insurance options.

• Vision insurance available.

• Open and transparent communication channels with leadership.

• Initiatives focused on community and environmental impact.

• A development-oriented environment that offers autonomy to shape your career path.

• An inclusive, equal opportunity work environment that is barrier-free.

• Accommodations available during the recruitment process.