Coding Quality Reviewer and Educator-3

SUMMARY: Report ing

to the

Professional Validation Manager, t

he

Coding Quality Reviewer and Educator

• is responsible for
• performing comprehensive audits of professional coding and clinical documentation across a multispecialty ambulatory environment. This role
• validates
• the
• accurate
• assignment of ICD-10-CM, CPT, and HCPCS codes
• in accordance with
• CMS regulations, payer policies, organizational standards, and industry guidelines.
• This position conducts both prospective and retrospective reviews of provider and coder-selected codes, documents audit findings in a clear, objective, and non-leading manner, and
• identifies
• trends, risks, and opportunities for improvement.
• Serving as a subject matter expert, the Coding Quality Reviewer and Educator develops and delivers targeted education to coders, providers, and clinical departments to support compliant, defensible documentation and
• optimal
• revenue integrity outcomes.

This role requires expert-level coding knowledge, strong analytical and critical thinking skills, and the ability to work independently in a fully remote environmen
t.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences
Patient and Community Focus and Collaborate
RESPONSIBILITIES:
Perform prospective and retrospective audits of professional coding and medical records to

validate

accuracy and completeness of ICD-10-CM, CPT, HCPCS, and modifier assignment.

Evaluate clinical documentation to ensure services billed are supported, medically necessary, and compliant with CMS, federal, payer-specific, and organizational requirements.

Validate

• both coder and provider
• assigned codes; document findings, variance details, and supporting rationale in a clear,
• objective , and audit-defensible format.
• Apply non-leading, compliant review methodologies consistent with ACDIS/AHIMA guidance.

Identify

root causes of coding and documentation discrepancies and collaborate with leadership to develop corrective action plans.

Develop and

• conduct
• targeted education to coders, providers, and clinical departments based on audit findings, coding updates, and
• identified
• trends.
• Track and trend audit results to
• identify
• systemic risks and opportunities for process improvement.
• Research coding and documentation guidelines from
• qualified
• sources,
• collects
• relevant
• information
• and
• compiles

that information into a user-friendly ma
nual
.

S tays current on coding updates,

certification

requirements , and

expertise

pertinent to the position .

Key Skills

Expert

knowledge of:

ICD-10-CM, CPT, and HCPCS Level II coding guidelines

• E/M coding and/or surgical/procedural coding
• Medical terminology, anatomy, and healthcare documentation
• Knowledge of teaching physician, split/shared visit, and incident-to billing requirements

Abilit

• y to
• interpret
• complex medical documentation and apply coding guidelines accurately

Ability to

• identify
• trends , analyze audit data,
• and recommend process improvement
• Ability to research and apply regulatory guidance from CMS,

MAC

• , and commercial payers.
• Perform detailed audit reviews using standardized audit tools and methodologies
• Communicate complex coding concepts clearly to providers and coders
• Strong attention to detail and organizational skills

Excellent written

and verbal

communication skills

Proficiency

with electronic health records (EHR), Epic experience

preferred

Proficiency

with Microsoft Office Suite

(Word, Excel, PowerPoint)

Compliance & Regulatory Adherence

Maintains expert-level compliance with CMS regulations, National Correct Coding Initiative (NCCI) edits, Medicare Administrative Contractor (MAC) guidance, payer policies, and organizational standards.

Participate in compliance initiatives to reduce coding-related denials and audit findings.

Ensures

• compliance with HIPAA ,
• organizational data privacy ,
• and security policie s .

Abides by the Standards of

Ethical Coding as set forth by the American Health Information Management

Association and the American Association of Professional Coders

.

Performance Metrics

Meet

• s or exceeds 95%
• coding
• accuracy rate

Achieve

s

productivity benchmarks

Demonstrate

s

consistent performance in accuracy, timeliness, and workload management

Adhere

s

to organizational coding guidelines, payer requirements, and documentation standards to support audit readiness and reimbursement integrity

Accurately

• audits assigned accounts , responds to
• inquires ,
• and provides education
• Delivers high-quality education that improves provider documentation and coding performance
• MINIMUM QUALIFICATIONS: Education
• High school diploma or equivalent required

Certifications

One or more of the following required:

CPC (Certified Professional Coder) – AAPC

CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA

If applicable, s

• pecialty certification in assigned area
• required
• within one (1) year of hire .

Experience

• Minimum of five (5) years of professional coding experience, preferably in a large academic or
• multispecialty
• setting.

Prior coding audit experience

• strongly
• preferred.

Prior

• experience performing provider
• and coder
• education
• strongly preferred.

Work Environment

Fully Remote

Must maintain a secure, private workspace to protect PHI
.

Required to use organization-approved secure systems (VPN, multi-factor authentication)
.

Maintains active communication via email, messaging platforms, and

attends

virtual meeting s , as scheduled .

Working conditions

Requires

• pro long ed computer use
• to review medical records .
• Ability to meet deadlines while achieving productivity and accuracy standards.

Independent action

Performs independently with minimal supervision and serves as a subject matter expert. Exercises advanced judgment in interpreting coding guidelines and resolving complex issues

within the department’s policies and practices.

Refers

specific complex problems to the supervisor when clarification of the departmental policies and procedures are

required .

Supervisory responsibility

None

Disclaimer

This job description is intended to describe the general nature and level of work performed. Duties and responsibilities may be adjusted based on organizational needs and regulatory requirements.

Pay Range: $67,724.80-$111,716.80
EEO Statement:
Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
Location:
Remote-Florida - N/A Tallahassee, Florida 32301
Work Type:
M-F 8:00 - 5:00
Work Shift:
Day
Daily Hours:

8 hours Driving Required: No