CPMA Educator, Auditor

🔥 1 hour ago

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $61k - $103.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1908

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • 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 implementation of and compliance with enterprise-wide and department coding policies and procedures • Perform and manage internal audits and reviews to assess coding, documentation, billing, and clinical coding compliance • Track internal audit results for PHS • Provide enterprise-wide training for coding, audit, physician, and clinician personnel • Support corrective action plans through auditing and training • Audit medical records and billing for accuracy; identify discrepancies and recommend actions • Respond to and conduct medical record reviews requested by external regulatory agencies and insurance companies • Serve as liaison to Information Services, Finance/Patient Financial Services, hospitals, medical group sites, health plan, home health, ambulance, compliance, and ancillary departments • Maintain current knowledge of clinical documentation standards and legal/regulatory requirements • Research coding, billing, and charging compliance issues; recommend and implement corrective action plans • Assist with the CDQA Annual Audit Work-plan • Respond to daily coding and auditing inquiries and perform ad-hoc analysis for management • Maintain working knowledge of PHS coding and auditing IT applications • Gather and analyze information and provide recommendations • Conduct coding, documentation, and compliance training, including EPIC EMR clinical documentation education • Assist with external defense audits • Conduct focused internal medical-record audits for correct coding, billing, and charging • Analyze and communicate audit results and findings to management • Investigate patient-care and billing concerns • Monitor reports and quality audits to ensure clinical coding functions meet standards

🎯 Requirements

• Associates degree required; 3 years of additional clinical healthcare related experience can be substituted in lieu of degree • 2 years clinical healthcare related experience • RN and audit experience preferred • 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 for assigned service lines • Computer skills, especially Microsoft Word, PowerPoint, and Excel • Must be able to travel to all PHS sites, including overnight travel • Working hours may vary based on assigned projects

🏖️ Benefits

• medical, dental, and vision benefits • short-term and long-term disability insurance • group term life insurance • optional voluntary benefits • Employee Wellness rewards program • Gift cards and other rewards for participating in wellness activities