Remote Coding Quality Auditor & Educator

Brown Medicine; United States; Remoto; USD 68.000 - 112.000; Tempo pieno

Descrizione del lavoro

Brown University Health is seeking a Coding Quality Reviewer and Educator to perform comprehensive audits of professional coding and clinical documentation across a multispecialty ambulatory environment. You will validate ICD-10-CM, CPT, and HCPCS codes in line with CMS rules and payer policies, and report audit findings objectively.

The role requires expert coding knowledge, strong analytical skills, and the ability to deliver targeted education to coders, providers, and departments.

Competenze

• High school diploma or equivalent required.
• CPC (Certified Professional Coder) – AAPC
• CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA
• If applicable, specialty certification in assigned area required within one (1) year of hire.
• Minimum of five (5) years of professional coding experience, preferably in a large academic or multispecialty setting.
• Prior coding audit experience strongly preferred.
• Prior experience performing provider and coder education strongly preferred.

Mansioni

• Perform prospective and retrospective audits of professional coding and medical records to validate accuracy and completeness of ICD-10-CM, CPT, HCPCS, and modifier assignment.
• Evaluate clinical documentation to ensure services billed are supported, medically necessary, and compliant with CMS, federal, payer-specific, and organizational requirements.
• Validate both coder and provider assigned codes; document findings, variance details, and supporting rationale in a clear, objective, and audit-defensible format.
• Apply non-leading, compliant review methodologies consistent with ACDIS/AHIMA guidance.
• Identify root causes of coding and documentation discrepancies and collaborate with leadership to develop corrective action plans.
• Develop and conduct targeted education to coders, providers, and clinical departments based on audit findings, coding updates, and identified trends.
• Track and trend audit results to identify systemic risks and opportunities for process improvement.
• Research coding and documentation guidelines from qualified sources, collects relevant information and compiles that information into a user-friendly manual.
• Stays current on coding updates, certification requirements, and expertise pertinent to the position.

Conoscenze

ICD-10-CM coding knowledge

CPT and HCPCS coding

Medical terminology

Analytical thinking

Education & teaching

Formazione

High school diploma or equivalent

CPC (Certified Professional Coder) – AAPC

CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA

Strumenti

Epic experience

Microsoft Office Suite

Descrizione del lavoro

Brown University Health is seeking a Coding Quality Reviewer and Educator to perform comprehensive audits of professional coding and clinical documentation across a multispecialty ambulatory environment. You will validate ICD-10-CM, CPT, and HCPCS codes in line with CMS rules and payer policies, and report audit findings objectively.

The role requires expert coding knowledge, strong analytical skills, and the ability to deliver targeted education to coders, providers, and departments.