Pro Fee Auditor/Educator

🕒 Yesterday

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $57.2k - $87.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1908

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Presbyterian Healthcare Services is an integrated, nonprofit healthcare system based in New Mexico that operates hospitals, urgent care clinics, specialty and primary care practices, virtual care (VirtualPRES), and health insurance plans. The organization provides a broad range of clinical services—including neuroscience, transplant, cancer care, surgery, behavioral health, and home health—while also running community health and charitable programs (financial assistance, community support, and partnerships with medical education). It offers individual, Medicaid, Medicare Advantage, and employer health plans, plus patient tools (MyChart/myPRES), billing support, and commitment to access and quality across the state.

📋 Description

• Support the Coding and documentation quality assurance (CDQA) team • Implementation of and compliance with enterprise-wide and department coding policies and procedures for PHS • Compliance to all external regulatory agency coding rules and regulations • Perform and/or manage on-site internal audits or reviews to assess compliance/quality monitoring • Serve as a resource on documentation, coding, billing, and coding compliance questions • Develop and present educational programs and information dissemination • Audit and training support for coding, audit, and physician personnel identified as low performers • Perform medical record and billing reviews of denied and appealed claims • Coordinate review and tracking of appealed claims and communication with affected payers • Research and interpret all regulatory agency regulations

🎯 Requirements

• High school diploma/GED required • Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS • Minimum of three (3) years experience in coding and/or auditing required • Audit experience preferred • Excellent written and verbal communication skills • Detail and results oriented • Ability to work independently and make independent decisions • Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required • Proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations • Excellent organizational and planning skills • Proficient with Microsoft Word, PowerPoint, and Excel applications • Must be able to use the internet and other resource applications for research purposes

🏖️ Benefits

• Medical • Dental • Vision • Short-term and long-term disability • Group term life insurance • Other optional voluntary benefits • Employee Wellness rewards program