Senior Pro Fee Coding Auditor & Educator

NorthBay Healthcare Group; Fairfield (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

NorthBay Health is seeking a Professional Fee Coding Auditor to oversee auditing of professional fee coding across Ambulatory/Hospitalist, Surgery, and Emergency Medicine. You will resolve pre-billing edits and review post-billing denials to ensure coding accuracy and payer compliance.

Your role includes education for coders and physicians and collaboration with leadership to strengthen workflows. Candidates should have extensive coding experience, certification (CPC/CCS-P/CPMA), and strong

Qualifications

• Minimum 5 years of professional fee coding experience across multiple specialties.
• Minimum 3 years of auditing and edit-resolution experience.
• Strong knowledge of anatomy, physiology, medical terminology, disease processes, and official coding guidelines.
• Requires CPC, CCS-P, or CPMA; CRC preferred in addition to one of the certifications above.
• High school diploma; associate's or bachelor’s preferred.

Responsibilities

• Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist, 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 feedback to coders and leadership.
• Assists in developing coder and physician education based on audit findings.
• 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.
• 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.
• 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 education, and coordinates with leadership to schedule and deliver educator sessions.
• Prepares education materials reflecting current CPT, HCPCS, ICD-10-CM, and payer guidance.
• Measures the effectiveness of education by tracking improvements in audits, edits, and denials.

Skills

Analytical skills

Coding knowledge

Microsoft Office

EHR systems

3M encoder

Communication

Education

Associate's degree

Bachelor's degree

Tools

3M Encoder

Microsoft Office

Job description

NorthBay Health is seeking a Professional Fee Coding Auditor to oversee auditing of professional fee coding across Ambulatory/Hospitalist, Surgery, and Emergency Medicine. You will resolve pre-billing edits and review post-billing denials to ensure coding accuracy and payer compliance.

Your role includes education for coders and physicians and collaboration with leadership to strengthen workflows. Candidates should have extensive coding experience, certification (CPC/CCS-P/CPMA), and strong