Reporting to the Professional Validation Manager, this role performs comprehensive audits of professional coding and clinical documentation across a multispecialty ambulatory environment. The position validates accurate assignment of ICD-10-CM, CPT, and HCPCS codes in accordance with CMS regulations, payer policies, organizational standards, and industry guidelines.
The role also reviews provider- and coder-selected codes prospectively and retrospectively, documents audit findings objectively, identifies trends and risks, and develops targeted education for coders, providers, and clinical departments to support compliant documentation and revenue integrity. This is a fully remote position requiring independent work and advanced coding expertise.
Minimum Qualifications
- High school diploma or equivalent required
- One or more of the following certifications required:
- CPC (Certified Professional Coder)
- CCS or CCS-P (Certified Coding Specialist / Physician-based)
- Specialty certification in the assigned area required within one year of hire, if applicable
- Minimum of 5 years of professional coding experience, preferably in a large academic or multispecialty setting
- Prior coding audit experience strongly preferred
- Prior experience providing coder and provider education strongly preferred
Key Skills
- Expert knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines
- Experience with E/M coding and/or surgical/procedural coding
- Strong understanding of medical terminology, anatomy, and healthcare documentation
- Knowledge of teaching physician, split/shared visit, and incident-to billing requirements
- Ability to interpret complex medical documentation and apply coding guidelines accurately
- Ability to identify trends, analyze audit data, and recommend process improvements
- Ability to research and apply regulatory guidance from CMS, MAC, and commercial payers
- Proficiency with EHR systems; Epic preferred
- Proficiency with Microsoft Office Suite
- Strong written and verbal communication skills
- Strong attention to detail, organization, and independent judgment
Location
Florida, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$67,725 - $111,717
Remote work allowed
Yes
Posted
1 month ago