CPC Auditor and Educator

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

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

• 57 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