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What You’ll Do
The Coding Compliance Auditor partners cross-functionally with clinical leadership, revenue cycle, and compliance teams to ensure accurate, complete, and timely coding for a first-of-its-kind pediatric risk-bearing provider. This highly visible role supports ongoing compliance and operational excellence by ensuring all coding activities align with national coding standards, regulatory requirements, and Imagine Pediatrics’ internal policies in a remote-first, high-growth environment.
- Review medical records and clinical documentation to ensure accurate, complete, and compliant coding in accordance with CMS regulations, federal and state guidelines (e.g., AHIMA, CMS, Medicaid), and payer-specific policies.
- Conduct routine and focused coding audits to identify documentation gaps, coding discrepancies, and areas of compliance risk.
- Collaborate with clinical leadership, revenue cycle, and compliance teams to resolve coding discrepancies and support accurate documentation practices.
- Communicate audit findings to providers and coding staff, providing actionable, audit-defensible recommendations and targeted education.
- Perform follow-up audits to validate remediation efforts and ensure sustained improvements in coding accuracy and compliance.
- Prepare written reports of findings to Compliance Leadership on charts reviewed per quarter, coding accuracy metrics, and identified risk areas.
- Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, providing guidance on complex or high-risk scenarios.
- Interpret and apply state-specific Medicaid and payer billing requirements, maintain expertise across multiple markets and ensure alignment with regulatory and contractual guidelines; continuously research, monitor, and educate providers and coding staff on emerging payer policies, state expansions, and industry changes.
What You Bring & How You Qualify
First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve.
- 5+ years of experience in professional fee coding and auditing, specializing in E/M and outpatient coding across a variety of clinical settings. Telehealth experience preferred.
- Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-10, DRG, etc.
- Prior coding or auditing experience in a Medicaid environment.
- Experience providing individual and group educational training to staff and providers using excellent verbal and written communication skills.
- Strong understanding of HEDIS measures and E/M coding, with the ability to evaluate documentation for quality measure compliance and audit-defensible coding practices.
- Bachelor’s degree in healthcare management or related field preferred
- Familiarity with EMR software (e.g., Athena Health)
- CPC, or CCS; and CPMA required
- Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences.
- Demonstrate a strong commitment to coding compliance and regulatory standards while applying critical thinking and flexibility within a value-based care model, where coding scenarios may require nuanced interpretation beyond traditional fee-for-service guidelines.
