[Hiring] Provider Auditor and Educator @Practice Resources

Role Description

The Provider Auditor & Educator is responsible for conducting comprehensive coding, documentation, and compliance audits for healthcare providers. This role partners with physicians, advanced practice providers, and clinical staff to improve documentation accuracy, coding compliance, quality measure capture, and risk adjustment performance. The Auditor & Educator serves as a subject matter expert in Evaluation and Management (E/M) services, ICD-10-CM, CPT, HCPCS Level II, Medicare guidelines, and value-based care initiatives.

• Perform prospective and/or retrospective audits of provider documentation, coding, and compliance, for multiple specialties, with a concentration on Primary Care.
• Review medical records to ensure accurate assignment of ICD-10-CM, CPT, and HCPCS Level II codes in accordance with current coding guidelines and payer requirements.
• Audit office and outpatient E/M services utilizing current AMA and CMS documentation and coding guidelines.
• Evaluate documentation supporting chronic condition reporting, HCC/risk adjustment coding, quality reporting measures, and preventive services.
• Review coding and documentation related to:
  • Office and outpatient visits
  • Annual Wellness Visits (AWV)
  • Preventive medicine services
  • Transitional Care Management (TCM)
  • Chronic Care Management (CCM)
  • Remote Patient Monitoring (RPM)
  • Advance Care Planning (ACP)
  • Behavioral health and screening services
  • Minor office procedures
  • Hospital visits
• Identify coding, documentation, and compliance opportunities and provide actionable recommendations to providers and leadership.
• Develop and deliver individualized provider education, group training sessions, coding updates, and documentation improvement initiatives.
• Provide guidance on medical decision making (MDM), diagnosis specificity, chronic condition management, and documentation best practices.
• Monitor compliance with CMS, Medicare Advantage, Medicaid, commercial payer, and regulatory requirements.
• Support quality, value-based care, and risk adjustment programs through accurate documentation and coding practices.
• Assist with denial analysis, appeal reviews, and coding-related payer inquiries.
• Maintain expertise in CPT, ICD-10-CM, HCPCS Level II, NCCI edits, CMS policies, and industry best practices.
• Track audit findings, provider performance trends, and educational outcomes.
• Collaborate with coding, compliance, quality, clinical operations, and provider leadership teams to achieve organizational goals.
• Serve as a coding and documentation subject matter expert for providers and operational leadership.

Qualifications

• Required
  • CPC, CCS-P, RHIT, RHIA, CPMA, CEMC, or equivalent coding certification.
  • Minimum of 5 years of professional coding, auditing, or documentation improvement experience.
  • Minimum of 3 years of experience auditing Primary Care, Internal Medicine, or Family Medicine providers.
  • Strong knowledge of:
    • CPT
    • HCPCS Level II
    • ICD-10-CM
    • E/M coding guidelines
    • CMS regulations
    • Medicare and Medicare Advantage requirements
  • Experience with provider education and physician documentation improvement.
  • Excellent verbal and written communication skills.
  • Strong analytical and problem-solving abilities.
• Preferred
  • CPMA, CEMC, or other auditing certification in combination with CPC.
  • Prefer experience with HCC/risk adjustment auditing and education.
  • Experience with quality programs including HEDIS, Stars, and value-based care initiatives.
  • Familiarity with Epic, eClinicalWorks, MEDENT, NextGen, Athena, or other EHR platforms.
  • Experience working in a remote auditing and education environment.

Key Competencies

• Provider Education & Engagement
• Coding Compliance
• Documentation Improvement
• Risk Adjustment/HCC Coding
• Primary Care Expertise
• Audit Methodologies
• Regulatory Compliance
• Quality Measure Capture
• Denial Prevention
• Critical Thinking & Analysis
• Communication & Relationship Building

Benefits

• Competitive salary
• Health insurance
• Dental insurance
• Vision insurance
• Disability and life insurance
• 401K/Roth 401K options
• PTO
• Flex spending