Coding Auditor and Educator Professional Fee
About The Position
The Coding Auditor and Educator Professional Fee supports the professional fee coding team by using ICD-10-CM, HCPCS, and CPT-4 classification systems. The role serves as a subject matter expert and resource for coding and billing inquiries and helps standardize coding practices across the organization. Responsibilities include conducting internal chart audits, identifying documentation gaps and trends, ensuring productivity and accuracy standards are met, and providing follow-up education. The position monitors regulatory and health plan changes and communicates updates so they can be implemented accurately and promptly. It also leads new-staff onboarding and develops and delivers ongoing education, including training on Risk Adjustment, HCCs, and MEAT criteria. Working with leadership, the role contributes to short- and long-term planning for compliant coding and billing practices. The position is open to remote candidates residing in the listed states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Mississippi, Nebraska, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wyoming, as well as Colorado, Kansas, and New Mexico.
Requirements
- High school diploma or GED.
- Two years of recent experience in professional billing (PB) coder audits, education, and training.
- Five years of experience coding professional fee records.
- One of the following credentials: CPC (AAPC), CCS, CCS-P, RHIT, or RHIA.
- Epic experience.
- Knowledge of professional fee coding rules and guidelines.
- Understanding of rules and regulations governing Medicare billing.
- Advanced knowledge of NCCI, ICD-10-CM, CPT, HCPCS, and modifiers.
- Advanced knowledge of medical terminology, anatomy, and physiology.
- Strong organizational, planning, scheduling, and project management abilities.
- Excellent analytical ability to develop and analyze data, recommend solutions, and solve complex problems.
Nice To Haves
- Associate degree, or equivalent work experience in lieu of a degree.
Responsibilities
- Maintain expertise in ICD-10, CPT, HCPCS, and regulatory guidelines to address complex billing inquiries.
- Conduct systematic chart audits to identify documentation gaps, track trends, and ensure productivity and accuracy standards are met.
- Lead onboarding for new hires and provide ongoing education on Risk Adjustment, HCCs, and MEAT criteria.
- Develop and deliver specialized training on changing health plan requirements and regulatory updates.
- Build and maintain effective relationships with coding teams to standardize practices and support cross-departmental communication.
- Manage deadlines, present educational findings, and drive improvements in coding compliance.
- Monitor regulatory changes and communicate updates for timely and accurate implementation.
- Participate with leadership in short- and long-term strategic planning for compliant coding and billing.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
