Coding Compliance Auditor

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Imagine Pediatrics

WebsiteLinkedInAll Job Openings

51 - 200 employees

🧘 Wellness

👥 B2C

Healthcare • Wellness • B2C

Imagine Pediatrics is a healthcare provider focused on delivering specialized pediatric care. The company is dedicated to improving children's health through personalized medical attention, preventive care, and effective treatment options. With a team of experienced professionals, Imagine Pediatrics aims to create a supportive and welcoming environment for children and their families, emphasizing the importance of a healthy start for all individuals.

📋 Description

• Review medical records and clinical documentation to ensure accurate, complete, and compliant coding in accordance with CMS regulations, federal and state guidelines (e.g., AHIMA, CMS, Medicaid), and payer-specific policies. • Conduct routine and focused coding audits to identify documentation gaps, coding discrepancies, and areas of compliance risk. • Collaborate with clinical leadership, revenue cycle, and compliance teams to resolve coding discrepancies and support accurate documentation practices. • Communicate audit findings to providers and coding staff, providing actionable, audit-defensible recommendations and targeted education. • Perform follow-up audits to validate remediation efforts and ensure sustained improvements in coding accuracy and compliance. • Prepare written reports of findings to Compliance Leadership on charts reviewed per quarter, coding accuracy metrics, and identified risk areas. • Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, providing guidance on complex or high-risk scenarios. • Interpret and apply state-specific Medicaid and payer billing requirements, maintain expertise across multiple markets and ensure alignment with regulatory and contractual guidelines; continuously research, monitor, and educate providers and coding staff on emerging payer policies, state expansions, and industry changes.

🎯 Requirements

• 5+ years of experience in professional fee coding and auditing, specializing in E/M and outpatient coding across a variety of clinical settings. Telehealth experience preferred. • Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-10, DRG, etc. • Prior coding or auditing experience in a Medicaid environment. • Experience providing individual and group educational training to staff and providers using excellent verbal and written communication skills. • Strong understanding of HEDIS measures and E/M coding, with the ability to evaluate documentation for quality measure compliance and audit-defensible coding practices. • Bachelor’s degree in healthcare management or related field preferred • Familiarity with EMR software (e.g., Athena Health) • CPC, or CCS; and CPMA required • Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences. • Demonstrate a strong commitment to coding compliance and regulatory standards while applying critical thinking and flexibility within a value-based care model, where coding scenarios may require nuanced interpretation beyond traditional fee-for-service guidelines.

🏖️ Benefits

• Competitive medical, dental, and vision insurance • Healthcare and Dependent Care FSA; Company-funded HSA • 401(k) with 4% match, vested 100% from day one • Employer-paid short and long-term disability • Life insurance at 1x annual salary • 20 days PTO + 10 Company Holidays & 2 Floating Holidays • Paid new parent leave • Additional benefits to be detailed in offer