Auditor Coder Specialist

Franciscan Medical Group; Tacoma (WA); Presencial; USD 70.000 - 95.000; Jornada completa

Descripción de la vacante

Virginia Mason Franciscan Health is seeking an Auditor Coder Specialist to safeguard financial integrity and regulatory compliance across the facility. You will conduct comprehensive audits of financial records, processes, and coding accuracy, identify risks, and provide actionable recommendations to enhance performance and prevent fraud.

You will review provider E/M profiles, respond to coding questions, and help develop training materials to improve documentation and billing compliance,

Formación

• Two years of ICD-10-CM and CPT coding in acute/ambulatory care settings.
• Certification as a coding specialist required upon hire (or equivalent).
• Certification in physician-based coding preferred at hire or equivalent.
• Certification as a CPC (Certified Professional Coder) upon hire.
• Experience in provider coding/documentation auditing is a plus.

Responsabilidades

• Performs internal audits and billing compliance reviews to ensure adherence to standards and guidelines.
• Reviews E/M profiles and practice patterns to identify compliance risks and opportunities for improvement.
• Documents audit results, tracks risks and trends, and communicates findings to stakeholders.
• Develops training materials and action plans to improve documentation and coding accuracy.
• Responds to coding questions and provides guidance on CPT/ICD-10-CM and reimbursement requirements.
• Reviews and corrects denied claims; suggests Epic edits and process improvements.
• Maintains project work lists and auditing software per procedures.

Conocimientos

ICD-10-CM coding

CPT coding

Auditing

Regulatory compliance

Educación

Certified Coding Specialist

Certified Coding Specialist - Physician Based

Certified Professional C coder

Herramientas

Epic

Descripción del empleo

Job Summary and Responsibilities

As our Auditor Coder Specialist, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility. Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making. To be successful, you’ll combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements.

• Performs internal audits and billing compliance reviews to ensure adherence to established quality standards, regulatory requirements, and coding guidelines.
• Reviews provider E/M profiles, practice patterns, and previous audit findings to identify compliance risks, missed billing opportunities, and areas for improvement.
• Documents audit results, tracks identified risks and trends, and communicates findings and recommendations to appropriate stakeholders.
• Identifies educational opportunities and assists with developing training materials and action plans to improve provider documentation, coding accuracy, and billing compliance.
• Responds to coding questions through the Coding Helpline, providing guidance to providers, managers, and billing teams on CPT, ICD-10-CM, reimbursement, regulatory requirements, and documentation standards.
• Reviews and corrects or appeals denied claims as assigned; recommends Epic edits and process improvements to support coding accuracy and compliance.
• Maintains project work lists and auditing software in accordance with established procedures.

Job Requirements

Required

• Two years of related work experience involving ICD-10-CM and CPT coding in an acute or ambulatory care setting that would demonstrate attainment of the requisite job knowledge/abilities. and
• Certified Coding Specialist, upon hire or
• Certified Coding Specialist - Physician Based, upon hire or
• Certified Professional Coder, upon hire

Preferred

• Work experience in provider coding/documentation auditing and/or provider training

Where You'll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area. Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person - body, mind, and spirit - in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth. Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care. We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.