The posting
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.
Accountabilities
- 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.
- Knowledge of teaching physician, split/shared visit, and incident-to billing requirements.
- Ability to interpret complex medical records and accurately apply coding, documentation, and regulatory guidelines.
- Strong understanding of CMS regulations, NCCI edits, MAC guidance, commercial payer policies, and organizational coding standards.
- Ability to research authoritative regulatory guidance and translate requirements into practical recommendations.
- Strong analytical and critical-thinking skills, including the ability to identify trends, assess root causes, and recommend improvements.
- Excellent written and verbal communication skills, with the ability to explain complex coding concepts clearly to both technical and nontechnical audiences.
- Strong attention to detail, organization, time management, and workload management skills.
- Proficiency with electronic health records; Epic experience is preferred.
- Proficiency with Microsoft Word, Excel, PowerPoint, and other relevant productivity tools.
- Ability to work independently with minimal supervision and exercise advanced judgment when resolving complex coding issues.
- Ability to maintain a secure, private remote workspace and use approved security measures such as VPN and multi-factor authentication.
- Comfortable working Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time.
- Fully remote work arrangement.
- Monday–Friday daytime schedule with 8-hour workdays.
- Salary range of $67,724.80–$111,716.80.
- Comprehensive healthcare and employee benefits offered as part of the overall compensation package.
- Opportunity to work in a multidisciplinary healthcare environment supporting coding quality, compliance, documentation integrity, and reimbursement accuracy.
- Independent subject matter expert role with opportunities to contribute to education and continuous process improvement.
- Collaborative virtual work environment with cross-functional interaction across clinical and operational teams.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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