Professional Fee Coding Auditor Claims Edit Specialist (Full-Time, Day)

AAPC

Fairfield (CA)

On-site

USD 90,000 - 120,000

Full time

6 days ago

Be an early applicant

Application generator

Get a reply from this employer — a resume and cover letter tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Medical insurance

Education reimbursement

Retirement plan

Job summary

NorthBay Health is seeking a Professional Fee Coding Auditor to audit professional fee coding across Ambulatory/Hospitalist, Surgery, and ED ProFee, ensuring CPT/HCPCS/ICD-10-CM accuracy and payer rule compliance.

The role involves resolving pre-bill edits, reviewing post-billing denials, and educating coders and physicians based on audit findings to strengthen coding workflows and documentation integrity.

Qualifications

Minimum 5 years of professional fee coding across multiple specialties.
Minimum 3 years of auditing and edit-resolution experience.
Strong knowledge of CPT, HCPCS, ICD-10-CM and payer policies.
Proficiency with encoders and common coding/billing software.

Responsibilities

Audit professional fee coding across Ambulatory/Hospitalist, Surgery, and ED ProFee.
Resolve pre-bill coding edits and validate CPT/HCPCS/ICD-10-CM accuracy.
Review post-billing denials and coordinate corrective actions with teams.
Develop coder and physician education based on audit findings.
Ensure compliance with CMS, AMA, OIG, and payer policies.

Skills

CPC

CCS-P

CPMA

Auditing

Healthcare coding

Education

Associate's or Bachelor's preferred

High School diploma preferred

Tools

3M encoder

EHR systems

Microsoft Office

Job description

Professional Fee Coding Auditor

At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.

PRIMARY JOB DUTIES

Audit Responsibilities

Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD-10-CM, and payer policies. Identifies trends, patterns, and recurring issues affecting coding quality or compliance. Prepares audit summaries and provides clear, constructive feedback to coders and leadership. Assists in developing coder and physician education based on audit findings.

Pre-Billing Edit Resolution

Reviews and resolves coding-related edits in pre-bill work queues within the current EHR/coding platform. Validates CPT/HCPCS, ICD-10-CM, and modifier accuracy to ensure clean claims prior to billing. Escalates documentation deficiencies to providers using established query processes. Identifies edit trends and recommends workflow or rules-based improvements.

Post-Billing Denials Review

Reviews coding-related denials and determines appropriate corrective action. Provides coding clarification for Billing, Revenue Integrity, and Denials teams. Tracks denial trends and collaborates with leadership to reduce recurrence.

Coder and Physician Education

Develops and delivers targeted coder education based on audit findings, pre bill/PB edit trends, and denial trends. Identifies documentation or coding patterns requiring physician level education, and coordinates with the Manager & Supervisor, Professional Coding, and/or Medical Staff leadership to schedule and deliver physician education as needed. Prepares education materials (tip sheets, presentations, case examples) reflecting current CPT, HCPCS, ICD 10 CM, and payer guidance. Measures the effectiveness of education provided by tracking improvement in subsequent audit, edit, and denial findings.

Compliance & Quality

Ensures all work complies with CMS, AMA, OIG, payer policies, and NorthBay standards. Maintains strict confidentiality and HIPAA compliance. Supports continuous improvement of coding workflows and audit processes.

Professional Standards

Performs other duties as assigned.

Qualifications

Education: High School diploma preferred; Associate's or Bachelor's preferred. Certification: Requires one of the following credentials: CPC, CCS-P, or CPMA. CRC (Certified Risk Adjustment Coder) preferred in addition to one of the certifications above. Experience: Minimum 5 years of professional fee coding experience across multiple specialties. Minimum 3 years of prior auditing and edit-resolution experience is required. Strong knowledge of anatomy, physiology, medical terminology, disease processes, and official coding guidelines.

Skills

Requires strong analytical skills, deep understanding of clinical documentation, and the ability to work independently with high accuracy in any EHR or coding/billing platform. Proficiency with EHRs, encoders (e.g., 3M), and Microsoft Office.

Interpersonal Skills

Communicates effectively with coders, providers, and cross-functional teams. Maintains professionalism under deadlines and shifting priorities.

Standards of Performance

Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Ability to sit for extended periods. Ability to lift/push/pull up to 5 lbs. Frequent keyboarding and sustained concentration.

About Us

Interpersonal Skills and Values. Demonstrates NorthBay Health's True North Values: Nurture Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence. These values guide behavior, accountability, teamwork, and commitment to high-quality patient care.

Why NorthBay Health

NorthBay Health is an independent, nonprofit health system serving the Napa, Solano, and Yolo County regions. We are expanding access to care across our communities through two acute-care hospitals, including a Level II Trauma Center and a Level III NICU maternity unit, along with a cancer center, urgent care locations, and a growing network of primary and specialty care clinics. We provide advanced services in cardiovascular care, neuroscience, orthopedics, surgery, and outpatient specialties. NorthBay Health is nationally recognized for quality care, including Magnet with Distinction designation for nursing and multiple U.S. News and World Report high performing recognitions. We are committed to being the trusted healthcare partner of choice and offer an environment where employees can grow, contribute meaningfully, and support the health of our communities.

NorthBay Health Benefits Options

Benefits may include medical, dental, and vision insurance, life, disability, and long-term care coverage, paid time off including vacation, sick leave, holidays, and bereavement, a 403(b) retirement plan with employer match, education reimbursement for eligible roles, professional development and training programs, Employee Assistance Program, wellness programs, recognition programs, shift differentials, and market-based compensation review and increases subject to approval and organizational performance.

Compensation Structure

Staff-level positions use a step-based system (Steps 1–5) based on years of directly related experience, with Step 5 representing 20 or more years of experience in the role.