Senior Compliance Coding Auditor CH (REMOTE)

Central Health; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Central Health is seeking a Senior Compliance Coding Auditor to conduct independent coding and billing audits across ambulatory and specialty care practices. The role supports the organization’s compliance program through risk-based auditing, education, and investigation of billing concerns.

The position requires advanced knowledge of ICD-10-CM, CPT, HCPCS, and E/M documentation, with experience in evaluating regulatory requirements and implementing corrective actions.

Qualifications

• Associates Degree (or higher) required or equivalent.
• Minimum 5 years of professional coding experience with procedural and diagnostic coding.
• At least 2 years of coding audit experience, with provider education and documentation review.
• CPC certification or equivalent credential preferred.

Responsibilities

• Auditing and monitoring of professional services across ambulatory and specialty care.
• Review documentation for CPT, HCPCS, ICD-10-CM and modifier accuracy.
• Identify coding and billing risks and recommend corrective actions.
• Ensure compliance with CMS, MAC, Medicaid, and commercial payer rules.
• Develop and deliver coding and compliance education for providers and staff.
• Collaborate with Revenue Cycle, IT, Finance, and Legal teams to support compliant practices.

Skills

Coding expertise

Regulatory compliance

Analytical thinking

Effective communication

Education

Associates Degree (or higher)

Tools

EHR systems

Auditing software

Excel

Job description

Overview

Reporting to the Director of Healthcare Compliance, the Senior Compliance Coding Auditor is responsible for conducting independent coding, billing, documentation, and regulatory compliance audits across ambulatory and specialty care practices. The position supports the organization's compliance program through risk-based auditing, monitoring, provider education, investigation of billing concerns, identification of revenue integrity risks, and development of corrective action plans. The Senior Compliance Coding Auditor serves as a subject matter expert for professional fee coding, documentation requirements, government and commercial payer regulations, and healthcare compliance standards. This role partners closely with physicians, advanced practice providers, practice leadership, revenue cycle, coding, clinical operations, and executive leadership to promote compliant billing and documentation practices.

Responsibilities

Essential Functions:

Auditing and Monitoring

Conduct retrospective and targeted prospective compliance coding audits (i.e. baseline, routine periodic, monitoring, and focused) of professional services

Review medical record documentation to validate CPT, HCPCS, ICD-10-CM, modifier assignment, medical necessity, and payer specific billing requirements

Identify coding, documentation, billing, and compliance risks and develop recommendations for improvement

Evaluate compliance with CMS, Medicare Administrative Contractor (MAC), Medicaid, and commercial payer regulations

Conduct specialty specific audits including procedural, surgical, and evaluation and management (E/M) services

Review provider documentation for completeness, accuracy, and support of services billed

Monitor corrective action plans and validate effectiveness of remediation efforts

Participate in annual compliance risk assessments and coding audit plan development

Analyze audit findings and identify trends, patterns, and opportunities for focused monitoring activities

Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested. Provider and Coding Education and Consultation

Communicate audit findings and recommendations to physicians, advanced practice providers, coders, leadership, and operational teams

Develop and deliver coding and compliance education programs for providers, coders, and staff

Provide ongoing guidance regarding: o CPT and HCPCS coding o ICD-10-CM diagnosis coding o E/M documentation requirements o Modifier utilization o Medical necessity documentation requirements o Specialty specific coding and billing guidelines

Serve as a subject matter expert resource for regulatory and payer-related coding questions

Work with the purchasing department to order and distribute annual coding materials for all clinical sites and departments.

Compliance Program Support

Support implementation and maintenance of the organization’s compliance coding auditing and monitoring program

Participate in policy development and revision related to coding and billing compliance

Collaborate with Revenue Cycle, Clinical Operations, Quality, Information Technology, Credentialing, Finance, and Legal teams as necessary to facilitate compliant coding and billing practices

Advise organization of government coding and billing guidelines and regulatory updates

Assist with investigations involving coding, billing, documentation, and reimbursement concerns.

Monitor regulatory updates and assess organizational impact.

Support compliance initiatives related to: o Medicare and Medicaid billing regulations o Commercial payer requirements o OIG compliance guidance o Documentation integrity o Revenue integrity

EHR and Documentation Intergrity

Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines. Reporting

Report findings and recommendations to compliance and leadership.

Prepare written audit reports, executive summaries, dashboards, and compliance metrics.

Present audit results and recommendations to leadership and designated committees.

Maintain documentation supporting audit methodologies, findings, and corrective action activities. Perform other duties as assigned.

Knowledge, Skills and Abilities:

• Advanced knowledge and demonstrated proficiency in the application of ICD-10-CM, CPT®, and HCPCS Level II coding guidelines, conventions, and regulatory requirements.
• Extensive knowledge of medical terminology, anatomy and physiology, disease processes, pharmacology, and clinical documentation requirements.
• Thorough understanding of Centers for Medicare & Medicaid Services (CMS) regulations, National Correct Coding Initiative (NCCI) edits, Office of Inspector General (OIG) compliance guidance, Medicare and Medicaid policies, and applicable payer-specific coding and billing requirements.
• Strong knowledge of healthcare compliance programs, auditing methodologies, reimbursement principles, and revenue integrity practices.
• Demonstrated ability to conduct complex coding and documentation audits, identify compliance risks, determine root causes, and recommend corrective actions.
• Ability to analyze coding, billing, and audit data; identify trends and patterns; and develop actionable recommendations for process improvement and risk mitigation
• Strong critical thinking, analytical, problem-solving, and decision-making skills.
• Exceptional attention to detail, accuracy, and organizational skills, with the ability to manage multiple priorities and meet deadlines.
• Excellent verbal, written, presentation, and interpersonal communication skills, including the ability to educate providers, leadership, and staff on coding, documentation, and compliance requirements.
• Proficiency in Microsoft Office Suite, including advanced Excel skills for data analysis and reporting.
• Experience utilizing electronic health records (EHRs), coding systems, auditing software, and compliance monitoring tools.
• Ability to collaborate effectively with clinical, operational, revenue cycle, and compliance stakeholders to support organizational compliance and revenue integrity objectives.
• Ability to interpret and apply evolving regulatory guidance, coding updates, and industry best practices to ensure organizational compliance and revenue integrity.

Qualifications

Education:

• Associates Degree (higher degree accepted)

Required Work Experience:

• Minimum of 5 years of progressively responsible experience in professional coding with demonstrated expert knowledge of procedural and diagnostic coding.
• Minimum of 2 years of coding audit experience, including provider education, documentation review, and evaluation of coding accuracy and regulatory compliance.
• Advanced knowledge of ICD-10-CM, CPT®, HCPCS Level II, National Correct Coding Initiative (NCCI) edits, Medicare Physician Fee Schedule, and applicable payer-specific billing and coding requirements.
• Extensive knowledge of federal and state healthcare compliance requirements, reimbursement methodologies, documentation standards, and audit processes.

Require License and Ceritifcations:

• Certified Professional Coder (CPC®) through AAPC