Coding Quality Reviewer and Educator
New
J
JobgetherHealthcare coding
Based in the United States, Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern TimeFull-TimeSenior
Salary67,724.8 - 111,716.8 USD per year
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Job Details
- Experience
- At least five years of professional coding experience
- Required Skills
- EHR
Requirements
- High school diploma or equivalent.
- At least five years of professional coding experience; experience in a large academic medical center, healthcare system, or multispecialty environment is preferred.
- One or more of the following certifications: CPC through AAPC, or CCS/CCS-P through AHIMA.
- Obtain specialty certification relevant to the assigned area within one year of hire, where applicable.
- Expert knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines.
- Strong knowledge of E/M coding and/or surgical and procedural coding.
- Solid understanding of medical terminology, anatomy, and clinical documentation.
- Knowledge of teaching physician, split/shared visit, and incident-to billing requirements.
- Strong understanding of CMS regulations, NCCI edits, MAC guidance, commercial payer policies, and organizational coding standards.
- Proficiency with electronic health records; Epic experience is preferred.
- Proficiency with Microsoft Word, Excel, PowerPoint, and other relevant productivity tools.
- Ability to maintain a secure, private remote workspace and use approved security measures such as VPN and multi-factor authentication.
- Comfortable working Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time.
Responsibilities
- Perform prospective and retrospective audits of professional coding and medical records, validating ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.
- Evaluate clinical documentation to confirm billed services are supported, medically necessary, and compliant with applicable requirements.
- Review coder- and provider-selected codes and document findings, variances, and supporting rationale.
- Identify root causes of coding and documentation discrepancies and collaborate with leadership on corrective action plans.
- Develop and deliver targeted education for coders, providers, and clinical departments based on audit findings, coding updates, and trends.
- Track and analyze audit results to identify systemic risks, recurring issues, and process improvement opportunities.
- Research coding, documentation, and regulatory guidance and compile relevant information into reference materials and manuals.
- Support compliance initiatives designed to reduce coding-related denials and audit findings.
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