Medical Coding Auditor/Educator

Core responsibilities

• Conduct pre-bill and post-bill audits of ICD-10-CM, CPT, and HCPCS Level II coding to ensure accuracy, compliance, and appropriate reimbursement.
• Review provider documentation for completeness, specificity, and medical necessity while identifying documentation improvement opportunities.
• Audit Evaluation & Management (E/M) coding using current Medical Decision Making and time-based guidelines.
• Evaluate modifier usage and identify coding trends, compliance risks, and opportunities for provider and coder education.
• Design, perform, and maintain routine coding audits across multiple specialties, providers, and markets.
• Maintain audit documentation, coding accuracy scorecards, and audit reports while supporting internal and external compliance reviews.
• Develop and deliver one-on-one and group education sessions focused on coding accuracy, documentation best practices, and regulatory compliance.
• Create coding resources, tip sheets, educational materials, and training programs for providers and operational teams.
• Support onboarding and ongoing coding education for new and existing providers.
• Partner with Revenue Cycle, Clinical, and Operational leaders to improve documentation workflows, optimize templates, and support coding automation and AI initiatives.
• Analyze coding quality metrics, audit trends, denial patterns, and provider performance, presenting findings and recommendations to leadership.
• Ensure compliance with CMS, AMA, HIPAA, payer-specific regulations, and organizational policies.
• Communicate findings and recommendations through virtual meetings, phone, and written communication.
• Support a multi-state organization by managing competing priorities and meeting audit deadlines.

Qualifications

• 3+ years of professional medical coding experience with coding audits, provider education, or documentation improvement experience.
• Pediatric, behavioral health, therapy, or multi-specialty healthcare experience preferred.
• Active coding certification such as CPC, CCS, CCS-P, or equivalent required.
• CPMA certification preferred or willingness to obtain within six months of hire.
• Strong knowledge of CPT, ICD-10-CM, HCPCS Level II, NCCI edits, modifier usage, and Evaluation & Management coding.
• Experience interpreting complex clinical documentation and applying coding guidelines accurately.
• Strong analytical skills with the ability to identify trends, root causes, and process improvement opportunities.
• Excellent presentation, facilitation, and communication skills with the ability to educate clinicians and provide constructive feedback.
• Strong organizational skills with the ability to manage multiple priorities while maintaining a high level of accuracy.
• Comfortable working independently while collaborating across clinical, operational, and revenue cycle teams.
• Ability to work flexible hours when needed to support multiple markets and provider schedules.

• Competitive compensation
• Comprehensive medical, dental, and vision insurance
• Company-paid life insurance
• 401(k) with company match
• Generous paid time off and company holidays
• Collaborative, mission-driven culture focused on improving pediatric healthcare
• Opportunity to make a direct impact on provider performance, compliance, and patient care