Coding Auditor and Provider Educator

NAH reserves the right to make hiring decisions based on applicants' state of residence if outside the state of Arizona. NAH currently hires for remote positions in the following states:

• Alabama
• Arizona
• Florida
• Georgia
• Idaho
• Indiana
• Kansas
• Michigan
• Missouri
• North Carolina
• Ohio
• Oklahoma
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• Virginia

The Coding Auditor & Provider Educator is a critical role responsible for ensuring the accuracy, completeness, and compliance of medical coding (CPT, HCPCS, ICD-10-CM) for professional services. This individual will conduct thorough coding audits, identify areas for improvement in documentation and coding practices, and develop and deliver targeted educational programs to physicians, advanced practice providers (APPs), and clinical staff. The primary goal is to optimize revenue integrity, mitigate compliance risks, and foster a culture of accurate and compliant documentation and coding.

Responsibilities
Coding Auditing & Compliance

• Performs prospective and retrospective audits of professional fee coding (CPT, HCPCS, ICD-10-CM) across various medical and surgical specialties, including Evaluation and Management (E/M) services, procedures, and ancillary services.
• Reviews medical record documentation to validate the accuracy and completeness of coded diagnoses and procedures, ensuring adherence to official coding guidelines (e.g., AMA CPT, CMS, ICD-10-CM Official Guidelines for Coding and Reporting), payer policies, and regulatory requirements (e.g., HIPAA, OIG work plans).
• Identifies coding discrepancies, documentation deficiencies, medical necessity issues, and potential compliance risks.
• Quantifies the financial impact of coding errors and identifies opportunities for revenue optimization while maintaining strict compliance standards.
• Prepares detailed audit reports, including findings, recommendations, and corrective action plans.
• Tracks and trend audit results to identify systemic issues, patterns of errors, and areas requiring focused education or process improvement.
• Stays current with changes in coding guidelines, payer policies, and healthcare regulations, and integrates these updates into audit methodologies.

Provider Education & Training:

• Develops, customizes, and delivers comprehensive coding and documentation education sessions for physicians, APPs, and clinical staff, both individually and in group settings (e.g., department meetings, grand rounds).
• Provides constructive, clear, and actionable feedback to providers on audit findings, offering practical guidance and examples for improving documentation and coding accuracy.
• Creates and updates engaging educational materials, job aids, quick reference guides, and coding resources.
• Serves as a subject matter expert for complex coding and documentation inquiries from providers and staff.
• Collaborates with revenue cycle, compliance, clinical operations, and IT departments to ensure alignment of coding practices with organizational goals and system capabilities.
• Monitors the effectiveness of educational interventions and adjusts strategies as needed to achieve desired outcomes.

Quality Improvement & Policy Development:

• Assist in the development, implementation, and revision of internal coding policies, procedures, and best practices.
• Participate in compliance investigations related to coding and billing, providing expert analysis and recommendations.
• Contribute to continuous quality improvement initiatives within the revenue cycle, clinical documentation improvement (CDI), and compliance programs.
• Act as a liaison between clinical staff and billing/coding departments to facilitate effective communication and problem-solving.

Compliance & Safety:

• Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
• Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.
• If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
• Completes all company mandatory modules and required job-specific training in the specified time frame.
• Maintains confidentiality of all department, patient, and coding matters.
• Stays current with medical terminology and human anatomy.
• Meets industry standard measures of productivity and accuracy.

Qualifications
Education

• High School Diploma or GED- Required
• Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field - preferred

Certification & Licensures

• Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist – Physician (CCS-P) from AHIMA - Required
• Certified Professional Medical Auditor (CPMA) from AAPC - Required
• Certified Evaluation and Management Coder (CEMC) - Preferred
• Specialty-specific coding certifications (e.g., CIRCC, CCC, CGSC) - Preferred

Experience

• Minimum of 5-7 years of progressive experience in professional fee medical coding, with at least 3-5 years specifically in coding auditing and provider education within a healthcare system or large physician group.
• Extensive knowledge of CPT, HCPCS, and ICD-10-CM coding systems, official coding guidelines, medical terminology, anatomy, and physiology.
• In-depth understanding of CMS regulations, OIG work plans, HIPAA, and other relevant healthcare compliance standards.
• Demonstrated experience with various Electronic Health Record (EHR) systems and billing software.
• Exceptional analytical and problem-solving skills with meticulous attention to detail.
• Strong written and verbal communication skills, with the ability to present complex information clearly, concisely, and persuasively to diverse audiences (clinical and non-clinical).
• Excellent interpersonal skills, with the ability to build rapport, influence behavior, and provide constructive feedback effectively and diplomatically.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) for data analysis, report generation, and presentation development.
• Ability to work independently, manage multiple priorities, and meet deadlines in a dynamic, fast-paced environment.
• Strong ethical conduct and unwavering commitment to compliance and integrity.
• Demonstrated ability to adapt to changing regulations and technology.

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.