Professional Coding Auditor, Educator

Job Description:

• Research, collect, and analyze information supporting organizational objectives
• Identify opportunities, develop solutions, and lead issues through resolution
• Collaborate on performance improvement activities related to program efficiency and patient experience
• Distribute analytical reports
• Use multiple system applications to perform analysis, create reports, and develop educational materials
• Research and compile information for ad-hoc operational projects and initiatives
• Synthesize and analyze data, create graphical trend presentations, and recommend practical solutions
• Define and demonstrate progress, ROI, and operational impacts using program data and measurements
• Provide technical expertise in coding and documentation review for complex services, including surgical procedure code selection and high-acuity services
• Conduct comprehensive audits of professional coders and providers for accuracy, compliance, CPT, ICD-10, HCPCS, HCC, and payer-specific guideline alignment
• Analyze documentation and coding patterns to identify compliance, revenue integrity, and regulatory risks
• Provide actionable feedback to providers, coders, and leadership to improve documentation quality and coding accuracy
• Develop and deliver targeted education and training based on audit findings, regulatory updates, and knowledge gaps
• Train and onboard new audit and education colleagues and providers
• Maintain at least 95% accuracy in coding audits and complete the audit and education workplan

Requirements:

• Associate degree in Health Information Management or a related field, or an equivalent combination of years of education and experience
• Extensive knowledge of ICD-10, HCPCS, CPT, and HCC guidelines
• Knowledge of medical terminology, Medicare and Medicaid regulatory guidelines, and payer policies
• Five (5) or more years of professional coding experience, including surgical procedures
• Two (2) years of auditing and/or education experience
• Must possess one of: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Professional Certification (CPC)
• Bachelor's degree in health information management or related healthcare field preferred
• Preferred experience in auditing and provider education
• Preferred credentials: Certified Professional Medical Auditor (CPMA), Certified Risk Coder (CRC), or Clinical Documentation Expert – Outpatient (CDEO)
• Ability to use multiple system applications and computer technology
• Ability to maintain confidentiality, safety, and compliance with applicable laws and policies

Benefits:

• Equal Opportunity Employer commitment
• Mission- and values-driven workplace
• Professional development through audit education and training responsibilities