Senior Coding Quality Auditor

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🔥 0 minutes ago

🏄 California, Wisconsin – Remote

🏄 California – Remote 🧀 Wisconsin – Remote

💵 $100k - $140k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

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Indigenous Pact PBC, Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

Consulting • Insurance • Logistics

Indigenous Pact PBC, Inc. is dedicated to building health equity for Indian Country within one generation for a stronger future. They have developed a community care consultancy, which now includes a multi-state, board-certified physician group providing direct care to Tribal communities. Beyond healthcare consulting and advisory services, Indigenous Pact connects Tribes to a proactive healthcare provider network that delivers advanced specialty care, tailoring healthcare solutions to the unique needs of community members. They are committed to integrating traditional knowledge with modern, technology-supported care, offering an Indigenous-led healthcare approach that extends beyond Western medicine to ensure generational well-being in the communities they serve.

📋 Description

• Report to the Compliance Department Lead and work directly with the Revenue Cycle Management team • Ensure coding compliance and accuracy of claim submissions • Serve as the resource for coding research and coding accuracy, explaining the rationale and authoritative sources behind coding decisions • Act as coding subject matter expert for Tribal Care programs and new service or business lines • Research complex and new ICD-10-CM, CPT, HCPCS, and modifier questions • Monitor code set updates, CMS changes, and payer policy changes, and communicate guidance to coders • Research and vet coding, documentation, and reimbursement requirements for Tribal Care offerings, specialty programs, state expansions, and tribal healthcare operations • Provide implementation guidance to coding, billing, and operational teams • Collaborate with Revenue Cycle, Compliance, and Operations leadership on payer arrangements, encounter reporting, alternative payment models, and tribal healthcare reimbursement frameworks • Maintain a coding reference library • Conduct prospective and retrospective coding audits, track coder accuracy, and identify error trends • Review audit findings, support corrective action plans and re-audits, and analyze coding-related denials for root causes • Support external audit responses • Participate in implementation and expansion projects, develop coding workflows, education materials, and documentation standards • Foster compliance, integrity, and confidentiality under HIPAA and 42 CFR Part 2 • Perform other duties as assigned

🎯 Requirements

• Associate degree in Health Information Management or related field, or equivalent experience; bachelor’s degree preferred • Active coding credential required; CPMA preferred • Minimum of 5 years of coding experience, including 2 years of coding audits or quality reviews • Expert knowledge of official outpatient coding guidelines, NCCI, E/M rules, and outpatient payment methodologies • Strong research and auditing skills, with ability to document authoritative sources • Clear, tactful communication and experience training or leading coding staff • Knowledge of tribal healthcare reimbursement, encounter reporting requirements, and alternative payment models preferred • Expected working hours of 8:00am to 5:00pm • Ability to travel approximately 25% to Indigenous Pact work sites and clinic locations as needed • Ability to work in accordance with HIPAA and 42 CFR Part 2 • Interest or demonstrated history of working closely with Indian Country and Tribal communities

🏖️ Benefits

• PTO including vacation, wellness and 11+ company-paid holidays • 401(k) • Medical insurance • Dental insurance • Vision insurance • Open, transparent lines of communication with leadership • Community and environmental impact initiatives • Development-focused environment with autonomy to drive your career path • Equal opportunity and inclusive, barrier-free work environment • Recruitment-process accommodations available