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Professional Coder and Auditor
Location
United States
Posted
27 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Professional Coder and Auditor
J2 Integrity Solutions, LLC
Role Description J2 Integrity Solutions is seeking a Professional Coder/Auditor to support client engagements through a blended role that pivots between coding production and coding audit responsibilities. This position is ideal for a high-performing professional coder who is equally confident performing accurate and timely coding while also evaluating documentation and coding quality through structured audit reviews. The Professional Coder & Auditor will serve as a subject matter expert in ICD-10-CM, CPT, HCPCS, modifiers, and applicable CMS and payer-specific requirements. This role plays a key part in ensuring accurate billing, supporting revenue integrity, reducing compliance risk, and identifying education opportunities that strengthen documentation and coding performance. In addition to day-to-day coding and auditing work, this position will contribute to the development of educational tools and training materials to promote coding best practices and continuous improvement. The ideal candidate is detail-oriented, efficient, highly analytical, and able to pivot seamlessly between productivity-driven coding responsibilities and quality-focused audit work. Key Responsibilities - Pivot between production coding and audit responsibilities based on client needs and internal priorities. - Perform accurate, timely professional fee coding across assigned specialties and services, meeting defined productivity and quality benchmarks. - Assign appropriate ICD-10-CM, E/M, CPT, HCPCS, and modifiers in accordance with official guidelines and client-specific policies. - Ensure coding aligns with CMS, AMA, payer-specific policies, and NCCI edits to support clean claims and denials prevention. - Meet defined productivity and turnaround time expectations while maintaining high quality standards. - Conduct structured audits of coded encounters to validate coding accuracy, documentation integrity, and compliance. - Audit and validate E/M leveling using current CMS/AMA guidelines, including time and complexity-based models. - Identify under coding, over coding, missed charges, risk-adjustment and HCC opportunities, compliance risk, and revenue opportunities. - Document audit findings with clear rationale, applicable guideline references, and recommended actions. - Provide respectful, constructive feedback to coders, providers, and stakeholders, including navigating difficult conversations when needed. - Identify trends, root causes, and recurring patterns impacting coding quality and documentation, and translate them into practical education and process recommendations. - Develop tip sheets, SOPs, job aids, and training tools to promote coding consistency and best practices. - Deliver targeted data-driven education and coaching based on audit findings and performance gaps. - Collaborate with Coding, CDI, Revenue Integrity, and Compliance teams to support denial prevention, revenue protection, and accurate quality reporting. - Serve as a professional representative and brand ambassador of J2 Integrity Solutions, modeling integrity, and client-focused problem solving. - Roll up your sleeves to assist with the day-to-day support needed. Create internal policies, procedures, and work efforts at J2. - Other duties as assigned. Qualifications - Certification: CCS, CCS-P, CPC, RHIT, RHIA, CPMA, or equivalent required. - Experience: 3+ years of multi-specialty professional fee coding experience, including E&M. 2+ years of professional coding audit experience strongly preferred. Prior experience in a consulting or multi-client environment is a plus. - Technical Proficiency: Experience with EHR and encoders. Epic preferred. - Industry Knowledge: Deep understanding of ICD-10-CM, CPT, HCPCS, HCC, modifier application, CMS and AMA documentation standards, NCCI edits and payer-specific requirements, and risk adjustment methodologies. - Skills: Strong written and verbal communication skills, including the ability to deliver feedback clearly and confidently. Ability to work independently in a remote environment, manage competing priorities, and pivot between coding production and audit responsibilities based on client needs. High degree of accountability, integrity, and follow-through in meeting deadlines and delivering quality work. Ability to use data (dashboards, spreadsheets, and metrics) to track trends and outcomes of audits and education. Benefits - At J2 Integrity Solutions, we are committed to excellence, integrity, and innovation in healthcare coding and compliance. - As part of our team, you will have the opportunity to drive meaningful changes, support diverse clients, and be part of a dynamic team of professionals.
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