Professional Coding Audit & Educator (Remote)

📋 Description

• • Serve as a senior-level subject matter expert, driving the evaluation, design, and continuous improvement of professional coding quality and compliance controls across Stanford Health Care.
• • Ensure professional coding practices rigorously adhere to federal and state regulations, including CMS and OIG guidance, AMA CPT and ICD-10-CM Official Coding Guidelines, and all applicable payer policies.
• • Lead and execute comprehensive professional coding quality audits utilizing standardized methodologies and scoring frameworks to meticulously assess coding accuracy, documentation support, and overall compliance risk.
• • Establish and maintain consistent audit approaches, ensuring the integrity and defensibility of all audit findings.
• • Standardize reporting structures to effectively support organizational monitoring, regulatory readiness, and strategic continuous improvement initiatives.
• • Foster strong cross-functional partnerships with Professional Coding Leadership, Revenue Integrity, Compliance, Clinical Departments, and Operational Leaders to translate complex audit findings into tangible, actionable outcomes.
• • Develop and deliver targeted, impactful education programs for coding staff, School of Medicine Departments and Divisions, and clinical stakeholders, directly addressing audit outcomes, regulatory updates, and identified knowledge gaps.
• • Act as a primary subject matter expert for the interpretation and application of intricate professional coding guidelines, providing authoritative guidance on challenging coding scenarios, evolving regulatory requirements, and precise documentation expectations.
• • Conduct thorough risk-based assessments to strategically prioritize audit focus areas, with a keen eye on new services, high-risk procedures, and areas undergoing significant regulatory or operational change.
• • Partner collaboratively with Coding Leadership, Compliance, Revenue Integrity, and operational stakeholders to transform audit findings into concrete process improvements, workflow optimizations, and recommendations for system enhancements.
• • Actively support organizational coding accuracy and compliance initiatives by diligently monitoring performance against established accuracy benchmarks and proactively recommending corrective action plans when deviations are identified.
• • Prepare and present clear, concise audit results, insightful trend analyses, and impactful education outcomes to leadership and operational teams, promoting transparency, accountability, and a culture of continuous improvement.
• • Maintain an up-to-date and comprehensive understanding of all regulatory changes, coding updates, payer policies, and industry best practices to ensure audit methodologies and education content remain current, relevant, and fully compliant.
• • Participate actively in internal and external audit preparation activities, providing critical support to ensure organizational readiness and a seamless audit process.
• • Contribute significantly to the development and ongoing maintenance of essential audit tools, comprehensive education materials, and standardized documentation, fostering consistency and excellence across the entire professional coding program.
• • Research, interpret, and effectively communicate federal, state, and payer-specific documentation, coding rules, and regulatory requirements, staying abreast of Medicare, Medi-Cal, and commercial payer policies, ICD-10-CM and CPT coding updates, and guidance from Coding Clinic and CPT Assistant.
• • Serve as a trusted subject matter expert and authoritative resource to coding staff, revenue integrity teams, and operational stakeholders on the precise application of professional coding standards and regulatory expectations.
• • Analyze clinical documentation and abstract relevant information from medical records to rigorously support accurate coding and compliance evaluations.
• • Apply strong organizational and project management skills to effectively manage multiple priorities within a dynamic and evolving regulatory environment.
• • Uphold a strong commitment to ethical coding standards, aligning with AHIMA and/or AAPC professional guidelines.
• • Ensure all activities align with Stanford Health Care's commitment to providing an exceptional patient and family experience, embodying the C-I-CARE standards.