Coding Compliance Auditor

 The Coding Compliance Auditor partners cross-functionally with clinical leadership, revenue cycle, and compliance teams to ensure accurate, complete, and timely coding for a first-of-its-kind pediatric risk-bearing provider. This highly visible role supports ongoing compliance and operational excellence by ensuring all coding activities align with national coding standards, regulatory requirements, and Imagine Pediatrics’ internal policies in a remote-first, high-growth environment.

• →Review medical records and clinical documentation to ensure accurate, complete, and compliant coding in accordance with CMS regulations, federal and state guidelines (e.g., AHIMA, CMS, Medicaid), and payer-specific policies.
• →Conduct routine and focused coding audits to identify documentation gaps, coding discrepancies, and areas of compliance risk.
• →Collaborate with clinical leadership, revenue cycle, and compliance teams to resolve coding discrepancies and support accurate documentation practices.
• →Communicate audit findings to providers and coding staff, providing actionable, audit-defensible recommendations and targeted education.
• →Perform follow-up audits to validate remediation efforts and ensure sustained improvements in coding accuracy and compliance.
• →Prepare written reports of findings to Compliance Leadership on charts reviewed per quarter, coding accuracy metrics, and identified risk areas.
• →Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, providing guidance on complex or high-risk scenarios.
• →Interpret and apply state-specific Medicaid and payer billing requirements, maintain expertise across multiple markets and ensure alignment with regulatory and contractual guidelines; continuously research, monitor, and educate providers and coding staff on emerging payer policies, state expansions, and industry changes.

First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve.

• 5+ years of experience in professional fee coding and auditing, specializing in E/M and outpatient coding across a variety of clinical settings. Telehealth experience preferred.
• Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-10, DRG, etc. 
• Prior coding or auditing experience in a Medicaid environment.
• Experience providing individual and group educational training to staff and providers using excellent verbal and written communication skills. 
• Strong understanding of HEDIS measures and E/M coding, with the ability to evaluate documentation for quality measure compliance and audit-defensible coding practices.
• Bachelor’s degree in healthcare management or related field preferred 
• Familiarity with EMR software (e.g., Athena Health)  
• CPC, or CCS; and CPMA required  
• Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences.
• Demonstrate a strong commitment to coding compliance and regulatory standards while applying critical thinking and flexibility within a value-based care model, where coding scenarios may require nuanced interpretation beyond traditional fee-for-service guidelines.