Description

JOB SUMMARY

The RCM CPC Auditor and Educator is responsible for auditing provider coding and documentation, delivering detailed feedback, and offering targeted education to improve accuracy and compliance. This role provides training, tools, and ongoing instruction to new and existing providers through both individual and group sessions. Key responsibilities include conducting medical record reviews, analyzing coding patterns, providing virtual education, and ensuring documentation meets the highest level of specificity in alignment with CMS guidelines. The position also focuses on building strong relationships with physicians, supporting compliance efforts, and contributing to continuous improvement in coding quality across the organization.

JOB RESPONSIBILITIES

Communicate coding requirements to providers in a clear and confident manner
Conduct quarterly audits and provide education to providers and coders
Create coding education curricula and training materials
Host virtual one-on-one or group training sessions
Develop and maintain effective auditing systems and processes
Validate provider documentation by reviewing coding samples, claims, and medical records
Create educational materials to assist providers in assessing patient health status
Provide feedback and identify performance improvement opportunities
Track and manage documentation and coding progress for assigned providers
Identify compliance issues and report findings in a timely manner
Present audit progress and outcomes to leadership
Support CMS Risk Adjustment Data Validation activities
Update educational materials to reflect guideline or clinical changes
Customize training content for various audiences (providers, support staff, specialists, etc.)
Stay current on coding, compliance, and HCC updates
Maintain professional knowledge through workshops, publications, and networking

Requirements

JOB QUALIFICATIONS

Certified Professional Coder (CPC) with proven experience
Knowledge of CMS guidelines
Proficiency with MS Office and database tools
Strong communication and interpersonal skills
Ability to manage sensitive and confidential information
Self-directed with strong independence and resourcefulness
JOB REQUIREMENTS

2+ years of Athena experience or super-user expertise
CPC and RHIT certifications required
At least 10 years of profee coding, auditing, and education experience, specifically in OB/GYN specialties (maternal-fetal medicine, complex OB, mammography), with strong surgical and E/M leveling skills
5–7 years of experience in Revenue Cycle
Strong communication, presentation, and project management abilities
Excellent problem-solving and writing skills
Proficient in Microsoft Word, PowerPoint, and Excel
Strong training and evaluative skills