Coding Quality Reviewer – Educator

Job not on LinkedIn

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $67.7k - $111.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Brown Medicine

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1995

🏥 Healthcare

📚 Education

🔬 Science

Healthcare • Education • Science

Brown Medicine is a medical practice group that has joined Brown Health Medical Group, providing integrated outpatient and specialty care across a network of providers under a single electronic health record. It offers patient-facing services such as primary and specialty care, televisits, and online patient portals (transitioning to MyChart), as well as administrative and billing support, and is affiliated with Brown University Health and the Warren Alpert Medical School.

📋 Description

• Perform prospective and retrospective audits of professional coding and medical records • Validate accuracy and completeness of ICD-10-CM, CPT, HCPCS, and modifier assignment • Evaluate clinical documentation to ensure services billed are supported, medically necessary, and compliant • Validate coder- and provider-assigned codes and document findings, variances, and rationale • Apply non-leading, compliant review methodologies consistent with ACDIS/AHIMA guidance • Identify root causes of coding and documentation discrepancies and collaborate with leadership on corrective action plans • Develop and conduct targeted education for coders, providers, and clinical departments • Track and trend audit results to identify systemic risks and process improvement opportunities • Research coding and documentation guidelines and compile information into a user-friendly manual • Stay current on coding updates, certification requirements, and relevant expertise • Participate in compliance initiatives to reduce coding-related denials and audit findings • Maintain compliance with CMS, NCCI, MAC guidance, payer policies, HIPAA, privacy and security policies, and ethical coding standards • Meet or exceed a 95% coding accuracy rate and productivity benchmarks • Audit assigned accounts, respond to inquiries, and provide education • Work independently with minimal supervision as a subject matter expert • Attend scheduled virtual meetings and maintain active communication through email and messaging platforms

🎯 Requirements

• High school diploma or equivalent required • One or more of the following certifications required: CPC (Certified Professional Coder) – AAPC; CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA • If applicable, specialty certification in assigned area required within one (1) year of hire • Minimum of five (5) years of professional coding experience, preferably in a large academic or multispecialty setting • Expert knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines • Knowledge of E/M coding and/or surgical/procedural coding • Knowledge of medical terminology, anatomy, and healthcare documentation • Knowledge of teaching physician, split/shared visit, and incident-to billing requirements • Ability to interpret complex medical documentation and apply coding guidelines accurately • Ability to identify trends, analyze audit data, and recommend process improvement • Ability to research and apply regulatory guidance from CMS, MAC, and commercial payers • Proficiency with electronic health records; Epic experience preferred • Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint) • Strong attention to detail and organizational skills • Excellent written and verbal communication skills • Must maintain a secure, private workspace to protect PHI • Required to use organization-approved secure systems (VPN, multi-factor authentication) • Ability to meet deadlines while achieving productivity and accuracy standards