Remote Provider Auditor and Educator

Practice Resources LLC, a multi-specialty practice management company is looking for an experienced Provider Auditor and Educator. This is a fully remote position, with flexible hours after the training period, that allows you to manage a healthy work-life balance. The pay range for this position is $18.00-$30.00 per hour.

The Provider Auditor & Educator is responsible for conducting comprehensive coding, documentation, and compliance audits for healthcare providers. This role partners with physicians, advanced practice providers, and clinical staff to improve documentation accuracy, coding compliance, quality measure capture, and risk adjustment performance. The Auditor & Educator serves as a subject matter expert in Evaluation and Management (E/M) services, ICD-10-CM, CPT, HCPCS Level II, Medicare guidelines, and value-based care initiatives.

• Perform prospective and/or retrospective audits of provider documentation, coding, and compliance, for multiple specialties, with a concentration on Primary Care.
• Review medical records to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in accordance with current coding guidelines and payer requirements.
• Audit office and outpatient E/M services utilizing current AMA and CMS documentation and coding guidelines.
• Evaluate documentation supporting chronic condition reporting, HCC/risk adjustment coding, quality reporting measures, and preventive services.
• Review coding and documentation related to Office and outpatient visits
• Review coding and documentation related to Annual Wellness Visits (AWV)
• Review coding and documentation related to Preventive medicine services
• Review coding and documentation related to Transitional Care Management (TCM)
• Review coding and documentation related to Chronic Care Management (CCM)
• Review coding and documentation related to Remote Patient Monitoring (RPM)
• Review coding and documentation related to Advance Care Planning (ACP)
• Review coding and documentation related to Behavioral health and screening services
• Review coding and documentation related to Minor office procedures
• Review coding and documentation related to Hospital visits
• Identify coding, documentation, and compliance opportunities and provide actionable recommendations to providers and leadership.
• Develop and deliver individualized provider education, group training sessions, coding updates, and documentation improvement initiatives.
• Provide guidance on medical decision making (MDM), diagnosis specificity, chronic condition management, and documentation best practices.
• Monitor compliance with CMS, Medicare Advantage, Medicaid, commercial payer, and regulatory requirements.
• Support quality, value-based care, and risk adjustment programs through accurate documentation and coding practices.
• Assist with denial analysis, appeal reviews, and coding-related payer inquiries.
• Maintain expertise in CPT, ICD-10-CM, HCPCS Level II, NCCI edits, CMS policies, and industry best practices.
• Track audit findings, provider performance trends, and educational outcomes.
• Collaborate with coding, compliance, quality, clinical operations, and provider leadership teams to achieve organizational goals.
• Serve as a coding and documentation subject matter expert for providers and operational leadership.

• CPC, CCS-P, RHIT, RHIA, CPMA, CEMC, or equivalent coding certification.
• Minimum of 5 years of professional coding, auditing, or documentation improvement experience.
• Minimum of 3 years of experience auditing Primary Care, Internal Medicine, or Family Medicine providers.
• Strong knowledge of: CPT
• Strong knowledge of: HCPCS Level II
• Strong knowledge of: ICD-10-CM
• Strong knowledge of: E/M coding guidelines
• Strong knowledge of: CMS regulations
• Str…