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Role Description

The Medical Coding Auditor/Educator will evaluate, prepare, and present audit results and educational instruction to physicians, coders, and other staff using corporate approved audit and education tools and materials.

• Responsible for accurate and compliant coding and documentation review of pertinent medical records and physician services to identify need for coding education.
• Provide coding education to physicians, coders, and other staff involved in the coding and billing process.
• Assist in the formulation and improvement of division medical coding audit and education plans, materials, and processes.
• Review clinical documentation to ensure adherence to Government and third-party billing guidelines, AMA/AAP/CMS standards, Pediatrix algorithms, and internal coding policies.
• Follow Medical Coding Audit & Education policies and procedures to provide compliant coding education to Pediatrix teams.
• Provide instruction to physicians, coders, and staff on documentation standards and correct use of CPT‑4 and ICD‑10 codes.
• Assist in developing and maintaining Committee‑approved standardized coding education materials.
• Develop, review, and recommend updates to audit and education documents and templates to enhance overall auditing and education effectiveness.
• Evaluate coding requirements and prepare materials for physicians and staff prior to education sessions in a timely and effective manner.
• Produce accurate information when addressing coding inquiries and when preparing instructional session summaries.
• Perform miscellaneous compliance audits and participate in company audit and education projects as assigned by senior management.
• Resolve coding inquiries through coder email processes, patient dispute resolutions, and general education communication channels.
• Participate in audit, education, and coding team meetings to identify solutions for coding guidance or presentation issues.
• Meet or exceed departmental deadlines and performance goals consistently.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policies.

Qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P) designation required with current active status.
• 3-5 years of experience in hospital administration and/or multi-specialty physician practice, with full exposure to managing the accounts receivables, physician billing, and CPT-4/ICD-10 coding with medical terminology.

Requirements

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions and communicate them to physicians, coders, and other staff in a way that facilitates understanding.
• Software: NextGen EHR/EPM, GoTo Meeting, Microsoft PowerPoint, Excel and Word, FirstClass.
• Travel – this position may require travel to medical offices across an assigned geography as necessary, ranging from 25% to 50% each month dependent upon audit and education schedules. (Travel is reimbursed 100% by the company)

Benefits

• Comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being.
• Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program.
• Some benefits are provided at no cost, while others require a cost share between employees and the company.
• Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.