Professional Fee Compliance Auditor and Educator

Physician Coding and Auditing Specialist

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.

Work Experience

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.

Benefits

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