Coding Compliance Auditor

About the role

The Coding Compliance Auditor partners cross-functionally with clinical leadership, revenue cycle, and compliance teams to ensure accurate, complete, and timely coding for a first-of-its-kind pediatric risk-bearing provider. This role supports ongoing compliance and operational excellence by ensuring all coding activities align with national coding standards, regulatory requirements, and Imagine Pediatrics' internal policies.

Responsibilities

• 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, HCPCS, 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.

Qualifications

• Passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve.

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.
• 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

• Base salary range of $75,000 - $90,000 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable).
• 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.