Coding Education Quality Auditor – CPC CCS-P

• Conduct coding, billing, and documentation audits of NGPG/NGHS providers
• Evaluate documentation adequacy and accuracy supporting billed services, including ICD-9, ICD-10, CPT, HCPCS, and third-party payer codes
• Ensure medical necessity and compliance with documentation, coding, and billing standards
• Apply standardized audit scoring and findings methodologies
• Communicate audit results to physicians, physician leadership, senior management, Compliance, and staff
• Provide physician and coder education and recommend corrective actions
• Serve as a subject matter expert on documentation and coding rules and regulations
• Coordinate and perform professional services documentation and coding audits for outpatient records
• Review clinical documentation for completeness, accuracy, and data integrity
• Conduct daily audits for new, PRN, locum, and flagged providers until standards are met
• Review findings with providers and recommend improvements
• Train and orient new providers on coding and documentation expectations
• Prepare and deliver audit reports by provider and practice
• Track provider improvement and compliance
• Develop and deliver coding education, training programs, and updates
• Support denial management by reviewing CPT denials and implementing corrective actions
• Support operational needs including claims, queues, and escalations

• CPC and/or CCS-P Coding Certification
• CPMA, CEMC, or other nationally recognized healthcare auditing certification required at hire or within 6 months of hire
• High School Diploma or GED
• Minimum of three (3) years of experience in a healthcare role involving direct application of CPT, ICD-10-CM, and/or modifiers in coding, auditing, or documentation review
• Ability to apply coding guidelines to complex, multi-specialty documentation
• Ability to identify errors, discrepancies, and compliance risks within medical records
• Ability to translate audit findings into clear, actionable feedback and process improvements
• Demonstrated experience educating providers and presenting to large audiences
• Advanced knowledge of ICD-9, ICD-10, CPT, HCPCS coding principles, and medical terminology
• Strong understanding of coding policies, procedures, and regulatory/third-party requirements
• Advanced proficiency in Microsoft Office, including Excel and Power Point
• Ability to communicate complex coding concepts to technical and non-technical audiences
• Strong data organization, analytical skills, and detailed reporting capabilities
• Skilled in developing and delivering presentations to diverse audiences
• Ability to work independently and collaboratively
• Ability to read, write, reason, talk, keyboard, and drive

Demonstrates expertise in coding and documentation audits, with a strong focus on compliance, accuracy, and education. Proficient in translating complex coding concepts and audit findings into actionable feedback for providers and staff.

• CPC Coding Certification
• ICD-10-CM Proficiency
• CPT Coding Knowledge
• Healthcare Auditing Certification
• Data Organization Skills

• ICD-9 Coding
• ICD-10 Coding
• CPT Coding
• HCPCS Coding
• Documentation Review
• Audit Methodologies
• Compliance Standards
• Coding Guidelines Application
• Error Identification
• Reporting Capabilities

• Communication Skills
• Analytical Skills
• Presentation Skills
• Collaboration Skills
• Education and Training Skills

• CPC Certification
• CCS-P Certification
• CPMA Certification
• CEMC Certification

• Healthcare Auditing
• Medical Necessity
• Third-Party Payer Codes
• Documentation Standards
• Coding Policies

• Microsoft Office
• Excel
• Power Point