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Northern Arizona Healthcare · 1 week ago

Coding Auditor and Provider Educator - Remote (see full posting for eligible states)

United States

Full-time

Remote

Senior Level

5+ years exp

Northern Arizona Healthcare is seeking a Coding Auditor & Provider Educator responsible for ensuring the accuracy, completeness, and compliance of medical coding for professional services. This role involves conducting coding audits, providing education to healthcare providers, and optimizing revenue integrity while mitigating compliance risks.

Health CareMedicalNon Profit

Responsibilities

Performs prospective and retrospective audits of professional fee coding (CPT, HCPCS, ICD-10-CM) across various medical and surgical specialties, including Evaluation and Management (E/M) services, procedures, and ancillary services

Reviews medical record documentation to validate the accuracy and completeness of coded diagnoses and procedures, ensuring adherence to official coding guidelines (e.g., AMA CPT, CMS, ICD-10-CM Official Guidelines for Coding and Reporting), payer policies, and regulatory requirements (e.g., HIPAA, OIG work plans)

Identifies coding discrepancies, documentation deficiencies, medical necessity issues, and potential compliance risks

Quantifies the financial impact of coding errors and identifies opportunities for revenue optimization while maintaining strict compliance standards

Prepares detailed audit reports, including findings, recommendations, and corrective action plans

Tracks and trend audit results to identify systemic issues, patterns of errors, and areas requiring focused education or process improvement

Stays current with changes in coding guidelines, payer policies, and healthcare regulations, and integrates these updates into audit methodologies

Develops, customizes, and delivers comprehensive coding and documentation education sessions for physicians, APPs, and clinical staff, both individually and in group settings (e.g., department meetings, grand rounds)

Provides constructive, clear, and actionable feedback to providers on audit findings, offering practical guidance and examples for improving documentation and coding accuracy

Creates and updates engaging educational materials, job aids, quick reference guides, and coding resources

Serves as a subject matter expert for complex coding and documentation inquiries from providers and staff

Collaborates with revenue cycle, compliance, clinical operations, and IT departments to ensure alignment of coding practices with organizational goals and system capabilities

Monitors the effectiveness of educational interventions and adjusts strategies as needed to achieve desired outcomes

Assist in the development, implementation, and revision of internal coding policies, procedures, and best practices

Participate in compliance investigations related to coding and billing, providing expert analysis and recommendations

Contribute to continuous quality improvement initiatives within the revenue cycle, clinical documentation improvement (CDI), and compliance programs

Act as a liaison between clinical staff and billing/coding departments to facilitate effective communication and problem-solving

Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner

Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility

If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates

Completes all company mandatory modules and required job-specific training in the specified time frame

Maintains confidentiality of all department, patient, and coding matters

Stays current with medical terminology and human anatomy

Meets industry standard measures of productivity and accuracy

Qualification

CPT codingICD-10-CM codingHCPCS codingCertified Professional CoderCertified Coding SpecialistCoding auditingProvider educationElectronic Health Record systemsMicrosoft Office SuiteAnalytical skillsCommunication skillsInterpersonal skillsAttention to detail

Required

High School Diploma or GED- Required

Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist – Physician (CCS-P) from AHIMA - Required

Certified Professional Medical Auditor (CPMA) from AAPC - Required

Minimum of 5-7 years of progressive experience in professional fee medical coding, with at least 3-5 years specifically in coding auditing and provider education within a healthcare system or large physician group

Extensive knowledge of CPT, HCPCS, and ICD-10-CM coding systems, official coding guidelines, medical terminology, anatomy, and physiology

In-depth understanding of CMS regulations, OIG work plans, HIPAA, and other relevant healthcare compliance standards

Demonstrated experience with various Electronic Health Record (EHR) systems and billing software

Exceptional analytical and problem-solving skills with meticulous attention to detail

Strong written and verbal communication skills, with the ability to present complex information clearly, concisely, and persuasively to diverse audiences (clinical and non-clinical)

Excellent interpersonal skills, with the ability to build rapport, influence behavior, and provide constructive feedback effectively and diplomatically

Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) for data analysis, report generation, and presentation development

Ability to work independently, manage multiple priorities, and meet deadlines in a dynamic, fast-paced environment

Strong ethical conduct and unwavering commitment to compliance and integrity

Demonstrated ability to adapt to changing regulations and technology