Senior Coding Quality Auditor

Indigenous-Pact-Pbc; Eugene (OR); À distance; USD 100 000 - 140 000; Plein temps

Avantages offerts par ce poste

401(k)

Medical insurance

Dental insurance

Vision insurance

Résumé du poste

Indigenous Pact is seeking a Senior Coding Quality Auditor to join our Compliance Team. Remote position with approximately 25% travel to clinic locations in the Pacific Northwest, Wisconsin, and California.

Salary ranges from $100,000 to $140,000 annually and includes a comprehensive benefits package. You will lead coding quality initiatives, perform audits, and advise on ICD-10-CM, CPT, and HCPCS coding research.

Qualifications

• Experience with ICD-10-CM, CPT, HCPCS, and modifiers.
• Proven ability to research authoritative coding sources.
• Knowledge of tribal healthcare reimbursement preferred.

Responsabilités

• Conduct prospective and retrospective coding audits and track accuracy.
• Review audit findings and support corrective actions.
• Analyze coding denials and assist with external audit responses.
• Collaborate on Tribal Care implementation and expansion projects.
• Maintain coding reference library.

Connaissances

Outpatient coding guidelines

NCCI rules

Auditing skills

Research/documentation

Training staff

Formation

Associate degree in Health Information Management

CPMA certification

Bachelor's degree preferred

Outils

Coding audit software

CMS payer policies databases

Description du poste

Job Title: Senior Coding Quality Auditor
Department: Compliance Department
Reports To: Compliance Department Lead
Position Type: Full-Time, Exempt
Location: Remote with approximately 25% travel to clinic locations as needed (Pacific Northwest, Wisconsin, California)
Pay: $100-$140k.

JOB SUMMARY

Reporting to designated Compliance Department Leader, the Senior Coding Quality Auditor works directly with the Revenue Cycle Management (RCM) team to ensure coding compliance and the accuracy of claim submissions. The Auditor serves as the team’s resource for coding research and coding accuracy, reviews coding quality, and explains the reasoning and sources behind each coding decision so coders can apply it going forward. The Auditor is also the coding subject matter expert for Indigenous Pact’s Tribal Care programs and for any service line or business line Indigenous Pact decides to pursue, researching and vetting coding requirements before services launch.

DUTIES/RESPONSIBILITIES

Coding Research and Coding Requirements

• Research complex and new ICD-10-CM, CPT, HCPCS, and modifier questions using authoritative sources.
• Monitor code set updates and CMS and payer policy changes, and communicate clear guidance to coders.
• Research and vet coding, documentation, and reimbursement requirements for Indigenous Pact’s Tribal Care service offerings, specialty programs, state expansions, and tribal healthcare operations, as well as any other service line or business line Indigenous Pact decides to pursue, and provide implementation guidance to coding, billing, and operational teams.
• Collaborate with Revenue Cycle, Compliance, and Operational leadership to evaluate the coding impact of new payer arrangements, encounter reporting requirements, alternative payment models, and tribal healthcare reimbursement frameworks.
• Work through complex coding questions with coders, sharing the research and rationale behind each answer, and maintain a coding reference library.

Coding Quality Checks

• Conduct prospective and retrospective coding audits, track accuracy by coder, and identify error trends.
• Review audit findings with coders, explaining the guidance behind each correction, and support corrective action plans and re-audits as needed.
• Analyze coding-related denials for root causes and support external audit responses.

General Responsibilities

• Participate in Tribal Care implementation and expansion projects, and in the launch of any new service line or business line, by providing coding subject matter expertise, identifying coding-related risks, and helping develop coding workflows, education materials, and documentation standards.
• Foster a culture of compliance, integrity, and confidentiality in accordance with HIPAA and 42 CFR Part 2.
• Perform other duties as assigned.

Required Skills and Abilities

• Expert knowledge of official outpatient coding guidelines, NCCI, E/M rules, and outpatient payment methodologies.
• Strong research and auditing skills, with the ability to document authoritative sources.
• Knowledge of tribal healthcare reimbursement, encounter reporting requirements, and alternative payment models preferred.
• Clear, tactful communication and experience training or leading coding staff.

EDUCATION AND EXPERIENCE

• Associate degree in Health Information Management or related field, or equivalent experience; bachelor’s degree preferred.
• Active coding credential required; CPMA preferred.
• Minimum of 5 years of coding experience, including 2 years of coding audits or quality reviews.

Working environment:

• Expected working hours of 8:00am to 5:00pm.
• 25% travel to Indigenous Pact work sites may be required.

Building a strong culture and exhibiting our core values is important to us. When you join Indigenous Pact, you are joining a team that values:

• Empathy is at the heart of everything we do—we listen, we understand, and we put ourselves in the shoes of others, whether it's our teammates, our clients, or the communities we serve.
• Wisdom is about learning from experience, being thoughtful in our work and making decisions that are grounded in knowledge and insight. It's about taking the time to get things right.
• Bravery is having the courage to take bold risks, challenging the status quo, and knowing that growth happens when we push our limits.
• Transformation drives us to continuously grow—both as a company and as people. It’s about not being afraid to change and to keep pushing forward in the pursuit of excellence.

Visit our Careers page (https://www.indigenouspact.com/careers) where we encourage you to learn more about the characteristics that are important to us (and we hope you bring them as well) such as Healthcare-focused, growth mindset, self-motivated, collaborative, resilient and adaptable.

Beyond the job opportunity and incredible culture, we also offer:

• Indigenous Pact's PTO Policy includes vacation, wellness and 11+ company-paid holidays
• Competitive benefitsincluding 401(k), Medical, Dental, and Vision insurance
• Open, transparent lines of communication with leadership
• Committed togiving backto improving our communities and environmental impact
• A development-focused environment where you have autonomy to drive your career path

Indigenous Pact is an equal opportunity employer and we are dedicated to fostering an inclusive and barrier-free work environment for all employees and candidates.We are especially interested in candidates with lived experience in, or a demonstrated history of working closely with, Indian Country and Tribal communities. All qualified individuals are encouraged to apply. If accommodation is required during any stage of the recruitment process, please contact any member of our HR team. We thank all applicants for their interest; however, only those selected for interviews will be contacted.