Job Summary

Responsible for conducting independent physician coding and auditing reviews to ensure the accuracy, completeness, and compliance of medical record documentation supporting codes selected by providers and/or coders. This role ensures compliance with CMS guidelines, CPT, HCPCS, and ICD-10 code sets, while supporting providers through ongoing physician coding education, auditing feedback, compliance guidance, and training initiatives.

This position plays a key role in physician documentation improvement, coding compliance, audit readiness, and provider education across the organization.

Hybrid Work Expectations

To ensure collaboration, provider engagement, and training effectiveness, this position follows a hybrid work model with the following expectations:

Onsite Expectations:

• Mandatory in-office presence at least 1 day per week (Wednesday).
• Additional in-office days may be required for:
• Training sessions
• Provider meetings
• Department meetings
• Some weeks may require 2 days onsite depending on operational needs.
• Travel to provider sites may be required for education, auditing, and compliance support (travel is reimbursed).

Core Responsibilities Physician Coding, Auditing, Compliance & Education

• Conduct independent physician coding and auditing reviews to assess the adequacy of medical record documentation supporting codes selected by providers and/or coders.
• Perform detailed physician coding compliance audits to ensure adherence to CMS guidelines, CPT, HCPCS, ICD-10 code sets, and internal billing policies.
• Utilize MDaudit software to complete audit documentation, tracking, and reporting activities.
• Analyze provider, division, and departmental documentation and coding trends to identify compliance risks and recommend corrective actions.
• Support reporting of audit results, including trending, regulatory tracking, and responses to compliance inquiries.
• Develop and deliver physician coding education and training materials to improve documentation accuracy and coding compliance.
• Present physician coding audit findings and compliance risks to providers, leadership, and practice administrators.
• Create and administer targeted provider education and training programs to address documentation and coding gaps identified through auditing activities.
• Contribute to system-wide compliance education initiatives, including New Provider Education and Annual Compliance Training programs.

Compliance Auditing Operations & Process Support

• Prepare reports for compliance leadership and executive stakeholders, highlighting key findings from physician coding and auditing activities.
• Conduct regulatory research and draft responses to coding and compliance inquiries.
• Monitor and communicate regulatory updates impacting physician coding, documentation, and billing compliance.
• Document and track compliance cases, investigations, and inquiries within the case management system.
• Support compliance investigations related to documentation, billing, and coding concerns.
• Assist in developing policies, standard operating procedures, audit tools, and education toolkits to strengthen physician coding and auditing practices.

Performance Expectations

• Meet departmental KPIs, including:
• Audit productivity
• Audit quality/accuracy
• Turnaround time
• Provider education and training effectiveness
• Maintain strong knowledge of CMS, CPT, HCPCS, ICD-10, and payer documentation requirements.
• Perform other duties as assigned.

Qualifications

High school diploma.

Five (5) years experience in coding including two (2) years of auditing/billing compliance experience.

Certified Professional Coder (CPC) certification

Experience in and working knowledge of Corporate Compliance.

Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), or Certified Medical Auditor (CPMA) certification

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $31.78 - $44.50

Other Compensation (if applicable):

Review the 2025-2026 UMMS Benefits Guide