Senior Outpatient Coding Auditor & Provider Education Specialist

Responsibilities

• Conduct one-on-one and group education sessions with providers to explain observed billing trends, coding requirements and best practices.
• Reinforce appropriate documentation standards to support accurate code selection and reimbursement.
• Translate complex coding and reimbursement guidelines into clear, practical guidance tailored to provider workflows.
• Serve as a primary point of contact for providers participating in the education program.
• Respond to provider inquiries regarding coding guidelines, documentation requirements, and reimbursement policies in a timely and professional manner.
• Build trust and credibility with providers through respectful, transparent, and solution-oriented communication.
• Maintain a congenial and collaborative tone in all interactions.
• Effectively manage challenging conversations with providers, including those who may be frustrated or resistant to feedback.
• Utilize de-escalation techniques to address concerns, reduce tension, and guide discussions toward constructive outcomes.
• Balance enforcement of compliance standards with a supportive, educational approach.
• Perform detailed audits of outpatient medical records to assess accuracy of CPT, HCPCS, and ICD-10 coding, as well as compliance with payer policies and regulatory requirements.
• Identify patterns of coding variation, documentation deficiencies, and potential compliance risks.
• Develop audit findings, summaries, and provider-specific feedback reports with actionable recommendations.
• Ensure alignment with current coding guidelines, including AMA CPT®, CMS, NCCI, and payer-specific policies.

Qualifications

• Bachelor’s degree in Health Information Management, Healthcare Administration, or related field (or equivalent experience).
• Minimum of 5+ years of outpatient coding, auditing, or compliance experience.
• Active certification such as AAPC (e.g., CPC, CPMA) or AHIMA (e.g., CCS, CCS-P, RHIT, RHIA).
• Extensive knowledge of CPT, HCPCS, and ICD-10 coding systems, as well as CMS and payer reimbursement methodologies.
• Demonstrated experience auditing E/M services and other outpatient procedures.

Preferred Qualifications

• Experience in provider education or clinical documentation improvement (CDI).
• Experience working directly with physicians, advanced practice providers, and behavioral health clinicians.
• Background in healthcare analytics or performance improvement initiatives.

Core Competencies

• Communication Excellence: Ability to explain complex coding and reimbursement concepts clearly and effectively.
• Emotional Intelligence: Skilled at navigating sensitive conversations with professionalism and empathy.
• De-escalation & Conflict Management: Proven ability to manage and resolve challenging provider interactions.
• Analytical Thinking: Strong ability to understand and communicate provider billing trend metrics.
• Credibility & Influence: Builds trust with providers through expertise and respectful engagement.
• Adaptability: Able to tailor messaging based on provider specialty, experience, and receptiveness.

Benefits

A competitive benefits package, including healthcare, vision, dental, and 401(k) options.