Documentation & Coding Auditor - Billing Compliance

Performs coding and documentation quality audits, provides feedback to coding and reimbursement specialists, coders, and educates them. This job has no supervisory responsibilities.

High School graduate or equivalency and five (5) years of coding and reimbursement experience of which one (1) year may be as a coding auditor. Additional job-specific education may substitute for the experience.

Active professional coding certification from an accredited organization, e.g., American Association of Professional Coders (AAPC), American Health Information Management Association (AHIMA). Certification to remain current during term of employment. Knowledge of CPT, ICD-CM, ICD-10, and HCPCS nomenclature.

• Experience conducting risk-based and retrospective documentation and coding audits.
• Experience in an academic medical center, physician group practice, hospital, or other complex healthcare organization.
• Experience developing and delivering documentation, coding, and billing compliance education to physicians, advanced practice providers, residents, coders, and other staff.
• Experience preparing formal audit reports, identifying root causes, recommending corrective actions, and conducting follow-up monitoring.

• →Plan and perform proactive compliance activities, including risk-based audits, pre-bill or concurrent reviews, data monitoring, targeted education, policy or template reviews, and department consultations.
• →Identify and address billing compliance risks before issues escalate by using audit trends, payer updates, denial patterns, regulatory changes, stakeholder feedback, and risk assessment results.
• →Partner with departments before new services, workflows, locations, provider groups, or documentation tools are implemented to assess and reduce billing, coding, documentation, supervision, and reimbursement risks.
• →Maintain or contribute to tracking tools, such as issue logs, risk registers, work plan trackers, audit dashboards, corrective action trackers, education trackers, consultation logs, and reporting calendars.
• →Prepare and present ideas, findings, and information to appropriate staff.
• →Work collaboratively with providers, residents, coding staff, clinic administrators, leadership, and other stakeholders.