[Hiring] Auditor Coder Specialist @Franciscan Medical Group

Role Description

As our Auditor Coder Specialist, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility. Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making. To be successful, you’ll combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements.

• Performs internal audits and billing compliance reviews to ensure adherence to established quality standards, regulatory requirements, and coding guidelines.
• Reviews provider E/M profiles, practice patterns, and previous audit findings to identify compliance risks, missed billing opportunities, and areas for improvement.
• Documents audit results, tracks identified risks and trends, and communicates findings and recommendations to appropriate stakeholders.
• Identifies educational opportunities and assists with developing training materials and action plans to improve provider documentation, coding accuracy, and billing compliance.
• Responds to coding questions through the Coding Helpline, providing guidance to providers, managers, and billing teams on CPT, ICD-10-CM, reimbursement, regulatory requirements, and documentation standards.
• Reviews and corrects or appeals denied claims as assigned; recommends Epic edits and process improvements to support coding accuracy and compliance.
• Maintains project work lists and auditing software in accordance with established procedures.

Qualifications

• Two years of related work experience involving ICD-10-CM and CPT coding in an acute or ambulatory care setting that would demonstrate attainment of the requisite job knowledge/abilities.
• Certified Coding Specialist, upon hire or
• Certified Coding Specialist - Physician Based, upon hire or
• Certified Professional Coder, upon hire

Requirements

• Work experience in provider coding/documentation auditing and/or provider training (preferred).