Provider Coding Auditor & Educator at Munson Healthcare in Traverse City, Michigan, United States

Job description

• Job Description
• The Provider Coding Auditor & Educator is responsible for auditing clinician coding and documentation, delivering targeted provider education and supporting clinical documentation improvement (CDI) initiatives. This role promotes accurate, compliant coding and documentation practices for physicians and advanced practice providers. and partners with clinical, compliance, revenue cycle, and quality leadership to improve documentation quality, reduce compliance risk and support revenue integrity.

Responsibilities

• Perform independent professional fee coding and documentation audits for physicians and advanced practice providers (APPs), including Evaluation and Management (E/M), procedural, and diagnosis coding
• Evaluate clinician documentation to ensure accurate CPT, HCPCS, and ICD‑10‑CM code assignment, including E/M level selection and supporting medical decision‑making documentation
• Prepare clear, defensible written audit findings and recommendations identifying errors, trends, risks, and documentation improvement opportunities
• Deliver one‑on‑one provider education following audits to reinforce compliant coding and documentation practices
• Develop and present targeted education for clinicians and coding staff related to coding guidelines, documentation requirements, CDI principles, and identified risk areas
• Identify Clinical Documentation Integrity (CDI) gaps impacting accuracy, medical necessity, and defensibility, and support improvement efforts
• Support the development and maintenance of clinician documentation guidelines, best practices, and reference materials
• Monitor coding and documentation trends, including audit outcomes and denial drivers, and report findings to leadership and key stakeholders
• Collaborate with coding, CDI, compliance, revenue integrity, and clinical leadership to support documentation quality, audit readiness, denial prevention, and organizational initiatives
• Assist with documentation and coding education for new clinicians and support ongoing organizational coding and documentation improvement efforts
• Participate in compliance and revenue integrity activities, including internal reviews, payer inquiries, and audit‑related initiatives
• Maintain audit tracking tools and quality metrics to support reporting, trending, and continuous improvement
• Provide broad refresher education related to annual, quarterly, or interim coding and documentation changes and regulatory updates
• Travel to physician offices and clinical sites as needed to conduct on‑site audits and deliver in‑person education

Requirements

• Advanced knowledge of CPT, ICD‑10‑CM, HCPCS, and E/M coding guidelines, including payer‑specific and regulatory requirements.
• Ability to independently assess clinician documentation and coding accuracy, identify patterns, trends, and risk areas, and apply regulatory standards with consistency and professional judgment.
• Strong understanding of outpatient/physician CDI principles, including documentation specificity, medical necessity, clinical decision‑making, and accurate representation of patient complexity.
• Skilled in delivering clear, constructive, and collaborative education to physicians and advanced practice providers through one‑on‑one feedback, group training, and written guidance.
• Ability to work effectively with clinicians, compliance, revenue cycle, CDI, and leadership to support documentation quality, audit readiness, and organizational goals.
• Demonstrates professionalism, discretion, and confidence when interacting with clinicians and leadership, fostering trust and engagement across clinical settings.
• High level of precision in reviewing medical records, audit findings, and educational materials to ensure reliable outcomes and defensible documentation practices.
• Ability to manage priorities independently in a hybrid environment, adapt to regulatory changes, and balance remote and on‑site responsibilities
• High School Diploma/GED and 7 yrs total experience in professional coding experience including E/M and procedural coding across multiple specialties with at least 2 years of experience in professional coding audits, provider education, compliance reviews, and/or CDI
• OR
• Associates Degree in Health Information Management or a related healthcare field and 5 yrs total experience in professional coding experience including E/M and procedural coding across multiple specialties with at least 2 years of experience in professional coding audits, provider education, compliance reviews, and/or CDI
• CPC or CCS-P
• Required to obtain within 18 months of hire - CDEO

Skills

Required

• Audit and analytical judgment
• Stakeholder collaboration
• Attention to detail and accuracy
• Adaptability and independent work style

Benefits

• Grow: Tuition reimbursement, in-person and online development, and access to our career hub to help you advance.
• Thrive: Full benefits, paid holidays, generous PTO, employee discounts, and free individual retirement counseling.
• Be Well: Free wellness platform for you and your family, plus personalized support for personal or family challenges.
• Be Heard: Share your ideas and help shape the way we work through improvement huddles, employee surveys, and town hall meetings