The Medical Group Coding Auditor and Educator is responsible for auditing clinical documentation and coding practices to ensure accuracy, compliance, and adherence to national standards. This role involves educating both medical coders, providers and staff on coding best practices, documentation requirements, and payer-specific guidelines. The Auditor will apply expertise in coding principles, identify areas for improvement, and provide training to enhance the skills of both coders and healthcare providers.

Core Job Responsibilities

Perform thorough reviews of coded claims, ensuring compliance with ICD-10, CPT, HCPCS, HIPAA, HITECH and other coding standards and payer-specific requirements.
Identify coding errors, documentation inconsistencies and discrepancies in claims submitted for reimbursement. Coach and educate coders and providers.
Conduct detailed audits on medical records and clinical documentation to assess coding accuracy and completeness. Assess compliance with national standards for medical coding and billing.
Collaborate with coders to ensure accurate code assignment and provide feedback for improvement.
Review coding practices against payer-specific rules and regulations to ensure compliance.
Act as a liaison with the billing department, coding teams, healthcare providers, and other stakeholders to resolve coding and documentation-related claim rejections and denials.
Develop and deliver one-on-one or group training sessions for medical coders and healthcare providers on current coding standards that align with coding requirements, best practices, and ensure comprehensive and clear clinical notes for documentation improvements. Assist in creating educational materials.
Provide ongoing education to coders regarding updates to coding systems, regulations, and payer policies. Offer practical solutions to improve processes.
Monitor the effectiveness of training programs through assessments and feedback to ensure continuous improvement.
Track and report coding errors and trends, making recommendations for process improvements.
Assist in maintaining up-to-date coding policies, training content, and reference materials to ensure the organization stays compliant with regulatory changes.
Perform related duties as required.

Education/Experience Requirements

REQUIRED:

High school diploma or equivalent education.
3 years of experience as a medical coder, with at least 1 year in a coding review or educator role.
In-depth knowledge of compliance standards, including HIPAA, HITECH, and Medicare/Medicaid regulations.
Strong proficiency in coding software, electronic health record (EHR) systems, and healthcare management tools including MS Office.
Strong analytical skills to assess coding accuracy, identify trends, and resolve complex coding and documentation issues.
Ability to deliver constructive feedback and guide healthcare providers and coders in enhancing their documentation and coding practices.
Excellent communication and interpersonal skills, with the ability to educate and train diverse audiences.

Licensure/Certification Requirements

REQUIRED:

CPC (Certified Professional Coder), or CCS (Certified Coding Specialist), or equivalent certification through AAPC, AHIMA, or another nationally recognized credentialing body.

PREFERRED:

Certified Coding Specialist – Physician-based (CCS-P), or additional specialty certifications (e.g., CPMA (Certified Professional Medical Auditor).

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 94576
Department MEDICAL GROUP ADMINISTRATION
Shift Days
Shift Hours Worked 8.50
FTE 1
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $27 - $42/Hourly

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