Senior Coding Compliance Auditor and Educator

Senior Coding Compliance Auditor and Educator

General Job Summary : The Senior Coding Compliance Auditor and Educator will be responsible for auditing outpatient professional services documentation ensuring compliance with coding and billing guidelines , identif ying areas for improvement, and provid ing training to clinicians and coders to support accuracy, compliance, and adherence to industry standards. This role involves both auditing medical records and educating coders, providers, and staff on professional coding guidelines and best practices .

(this is a full-time position that will support our Compliance team, Monday to Friday 8 am to 5 pm, with the ability to work full remote)

Primary Job Responsibilities:

• Perform thorough reviews of outpatient professional claims and supporting documentation, 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.
• Collaborate with coders to ensure accurate code assignment and provide feedback for improvement.
• Review and stay up to date with 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 and/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.

Requirements :

Education and Experience:

• Bachelor’s degree in business or healthcare related field required.
• CPC (Certified Professional Coder), or CCS (Certified Coding Specialist), or equivalent certification through AAPC, AHIMA, or another nationally recognized credentialing body required.
• Certified Coding Specialist – Physician-based (CCS-P), or additional specialty certifications (e.g., CPMA (Certified Professional Medical Auditor) preferred.
• 5 years of experience as a medical coder, with at least 3 year2 in a coding review and/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.
• Excellent verbal and written communication skills.
• Possession of solid analytical/statistical skills used in evaluating and analyzing data.
• Proficient in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word).
• Experience working effectively with common office software, EMR and abstracting systems.
• 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.
• Knowledge of EMR for back-end reporting. Knowledge of Athena is a plus.

Physical Requirements

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds
• Ability to concentrate on details.
• Use of computer for long periods of time.