Coding Quality Reviewer and Educator

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Coding Quality Reviewer and Educator-3 based in the United States.

This fully remote role provides expert oversight of professional coding and clinical documentation across a multispecialty ambulatory healthcare environment.

You'll conduct prospective and retrospective audits to ensure coding accuracy, documentation integrity, compliance, and reimbursement support.

The role combines advanced coding expertise with analytical review, regulatory research, and provider and coder education.

You'll identify coding trends, risks, root causes, and improvement opportunities while helping teams strengthen their documentation and coding practices.

As a subject matter expert, you'll translate complex coding and regulatory requirements into practical guidance and targeted education.

The position offers significant independence, requiring sound judgment, meticulous attention to detail, and effective remote collaboration.

Your work will directly support audit readiness, compliance, revenue integrity, and continuous improvement across clinical operations.

• Perform prospective and retrospective audits of professional coding and medical records, validating ICD-10-CM, CPT, HCPCS Level II, and modifier assignment.

• Evaluate clinical documentation to confirm that billed services are supported, medically necessary, and compliant with CMS, federal, payer-specific, and organizational requirements.

• Review coder- and provider-selected codes and document findings, variances, and supporting rationale in a clear, objective, and audit-defensible manner.

• Apply compliant, non-leading audit methodologies consistent with applicable ACDIS and AHIMA guidance.

• Identify root causes of coding and documentation discrepancies and collaborate with leadership on corrective action plans.

• Develop and deliver targeted education for coders, providers, and clinical departments based on audit findings, coding updates, and emerging trends.

• Track and analyze audit results to identify systemic risks, recurring issues, and opportunities for process improvement.

• Research coding, documentation, and regulatory guidance from authoritative sources, compiling relevant information into accessible reference materials and manuals.

• Maintain current knowledge of coding updates, certification requirements, regulatory developments, and relevant industry practices.

• Support compliance initiatives designed to reduce coding-related denials and audit findings.

• Maintain adherence to HIPAA, data privacy, security requirements, and professional ethical coding standards.

• Accurately complete assigned audits, respond to inquiries, provide education, and meet established accuracy and productivity expectations.

• Work independently as a subject matter expert, escalating complex or unclear matters when departmental policy or regulatory interpretation requires additional guidance.

• High school diploma or equivalent required.

• At least five years of professional coding experience, preferably within a large academic medical center, healthcare system, or multispecialty environment.

• Prior coding audit experience strongly preferred.

• Prior experience educating providers and/or coding professionals strongly preferred.

• One or more of the following certifications required: CPC through AAPC, or CCS/CCS-P through AHIMA.

• Specialty certification relevant to the assigned area required within one year of hire, where applicable.

• Expert knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines.

• Strong knowledge of E/M coding and/or surgical and procedural coding.

• Solid understanding of medical terminology, anatomy, and clinical documentation.

• Knowled…