Coding Auditor and Educator Professional Fee

Mountain Region Out of State Staffing; Virginia Beach (VA); Remote; USD 90,000 - 120,000; Full time

Job summary

CommonSpirit Health is seeking a Coding Auditor and Educator – Professional Fee to support the professional fee coding team using ICD-10-CM, HCPCS, and CPT-4 classification systems. You will perform internal audits, provide follow-up education to ensure accuracy and compliance, and onboard new staff with ongoing training programs.

You will monitor regulatory changes, communicate updates to the PB coding teams, and participate with leadership in short- and long-term strategic planning to uphold

Qualifications

• Two years of PB coder audits, education, and training.
• Five years of experience coding professional fee records.
• CPC, CCS, CCS-P or RHIT/RHIA certifications required.
• Epic experience.
• Knowledge of professional fee coding rules and Medicare rules.
• Advanced knowledge of NCCI, ICD-10-CM, CPT, HCPCS and modifiers.
• Advanced knowledge of medical terminology and anatomy.

Responsibilities

• Maintain mastery of ICD-10, CPT, HCPCS, and regulatory guidelines as a high-level SME for complex billing inquiries.
• Conduct systematic chart audits to identify documentation gaps and track trends to meet productivity and accuracy standards.
• Lead onboarding and provide ongoing education on Risk Adjustment, HCCs, and MEAT criteria to improve documentation quality.
• Develop and deploy training programs to keep coding teams current on evolving health plan requirements and regulatory changes.
• Build strong cross-departmental relationships to standardize practices and improve communication.
• Independently manage deadlines, present findings, and drive improvements in coding compliance.

Skills

PB coder audits

Professional fee coding

CPC/CCS/CCS-P/RHIT/RHIA

Medicare billing rules

ICD-10-CM/CPT/HCPCS/modifiers

Medical terminology & anatomy

Analytical & problem solving

Organizational & project management

Regulatory knowledge

Data analysis & reporting

Education

Associate degree or equivalent

Tools

Epic

Job description

Where You'll WorkWith more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Job Summary and Responsibilities

As our Coding Auditor and Educator Professional Fee, you will utilize ICD-10-CM, HCPCS, and CPT-4 classification systems to support the professional fee coding team. You will serve as a key resource for coding and billing inquiries while facilitating the standardization of coding practices across the organization.Every day, you will perform internal audits and provide necessary follow-up education to ensure accuracy and compliance. You will also monitor evolving regulatory changes, effectively communicating these updates to ensure timely and precise implementation within the PB coding teams.In this role, you will be responsible for the onboarding and training of new staff, as well as the development and deployment of ongoing educational programs. Working in conjunction with leadership, you will participate in both short-term and long-term strategic planning to maintain excellence in compliant coding and regulatory billing practices.

• Maintain mastery of ICD-10, CPT, HCPCS, and regulatory guidelines to serve as a high-level subject matter expert for complex billing inquiries.
• Conduct systematic chart audits to identify documentation gaps, track trends, and ensure the team meets all established productivity and accuracy standards.
• Lead the onboarding process for new hires and provide continuous education on Risk Adjustment, HCCs, and MEAT criteria to improve documentation quality.
• Develop and deploy specialized training programs to keep coding teams current on evolving health plan requirements and regulatory changes.
• Build and maintain strong, diplomatic relationships with coding teams to facilitate the standardization of practices and effective cross-departmental communication.
• Utilize strong organizational and problem-solving skills to independently manage deadlines, present educational findings, and drive improvements in coding compliance.

Along with CO, KS and NM, this position is open to remote/out of state candidates residing in only these states:

• Alabama- Arizona- Arkansas- Colorado
• Florida- Georgia- Idaho- Indiana
• Iowa- Kansas - Kentucky- Louisiana
• Missouri- Mississippi- Nebraska- New Mexico
• North Carolina- Ohio- Oklahoma- South Carolina
• South Dakota- Tennessee- Texas- Utah
• Virginia- West Virginia- Wyoming

Job Requirements

Required

• High School Diploma/G.E.D.
• Two (2) years of recent experience in PB coder audits, education, and training
• Five (5) years of' experience coding professional fee records
• CPC Source: AAPC or CCS or CCS-P, or RHIT, or RHIA Source: AHIMA Certified Professional Coder (CPC Certification) CCS (Certified Coding Specialist) CCS-P (Certified Coding Specialists - Physician based) RHIT (Registered Health Information Technician) RHIA (Registered Health Information Administrator)
• Epic experience
• Knowledge of professional fee coding rules and guidelines.
• Understand rules and regulations governing Medicare billing
• Advanced Knowledge of NCCI, ICD-10-CM, CPT, HCPCS, and modifiers
• Advanced knowledge of medical terminology and anatomy and physiology
• Strong organizational, planning, scheduling and project management abilities
• Excellent analytical ability to develop and analyze data to recommend solutions and solve complex problems

Preferred

• Associate degree or equivalent work experience in lieu of degree