[Hiring] Senior Coding Quality Auditor @Indigenous Pact PBC, Inc.

Role Description

Reporting to designated Compliance Department Leader, the Senior Coding Quality Auditor works directly with the Revenue Cycle Management (RCM) team to ensure coding compliance and the accuracy of claim submissions. The Auditor serves as the team’s resource for coding research and coding accuracy, reviews coding quality, and explains the reasoning and sources behind each coding decision so coders can apply it going forward. The Auditor is also the coding subject matter expert for Indigenous Pact’s Tribal Care programs and for any service line or business line Indigenous Pact decides to pursue, researching and vetting coding requirements before services launch.

Duties/Responsibilities

• Coding Research and Coding Requirements
  • Research complex and new ICD-10-CM, CPT, HCPCS, and modifier questions using authoritative sources.
  • Monitor code set updates and CMS and payer policy changes, and communicate clear guidance to coders.
  • Research and vet coding, documentation, and reimbursement requirements for Indigenous Pact’s Tribal Care service offerings, specialty programs, state expansions, and tribal healthcare operations, as well as any other service line or business line Indigenous Pact decides to pursue, and provide implementation guidance to coding, billing, and operational teams.
  • Collaborate with Revenue Cycle, Compliance, and Operational leadership to evaluate the coding impact of new payer arrangements, encounter reporting requirements, alternative payment models, and tribal healthcare reimbursement frameworks.
  • Work through complex coding questions with coders, sharing the research and rationale behind each answer, and maintain a coding reference library.
• Coding Quality Checks
  • Conduct prospective and retrospective coding audits, track accuracy by coder, and identify error trends.
  • Review audit findings with coders, explaining the guidance behind each correction, and support corrective action plans and re-audits as needed.
  • Analyze coding-related denials for root causes and support external audit responses.
• General Responsibilities
  • Participate in Tribal Care implementation and expansion projects, and in the launch of any new service line or business line, by providing coding subject matter expertise, identifying coding-related risks, and helping develop coding workflows, education materials, and documentation standards.
  • Foster a culture of compliance, integrity, and confidentiality in accordance with HIPAA and 42 CFR Part 2.
  • Perform other duties as assigned.

Qualifications

• Expert knowledge of official outpatient coding guidelines, NCCI, E/M rules, and outpatient payment methodologies.
• Strong research and auditing skills, with the ability to document authoritative sources.
• Knowledge of tribal healthcare reimbursement, encounter reporting requirements, and alternative payment models preferred.
• Clear, tactful communication and experience training or leading coding staff.

Requirements

• Associate degree in Health Information Management or related field, or equivalent experience; bachelor’s degree preferred.
• Active coding credential required; CPMA preferred.
• Minimum of 5 years of coding experience, including 2 years of coding audits or quality reviews.
• Expected working hours of 8:00am to 5:00pm.
• 25% travel to Indigenous Pact work sites may be required.

Benefits

• Indigenous Pact's PTO Policy includes vacation, wellness and 11+ company-paid holidays.
• Competitive benefits including 401(k), Medical, Dental, and Vision insurance.
• Open, transparent lines of communication with leadership.
• Committed to giving back to improving our communities and environmental impact.
• A development-focused environment where you have autonomy to drive your career path.

Company Description

Indigenous Pact is an equal opportunity employer and we are dedicated to fostering an inclusive and barrier-free work environment for all employees and candidates. We are especially interested in candidates with lived experience in, or a demonstrated history of working closely with, Indian Country and Tribal communities. All qualified individuals are encouraged to apply. If accommodation is required during any stage of the recruitment process, please contact any member of our HR team. We thank all applicants for their interest; however, only those selected for interviews will be contacted.