The Network Coordinator, Coding Audit & Education performs internal, concurrent, prospective and retrospective coding audit activities. Reviews/validates coded medical records of Professional Coding (PC) staff to determine data quality and accuracy of coding, billing and documentation related to ICD-10, PCS, DRGs.CPT, APC's, and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements.
JOB DUTIES AND RESPONSIBILITIES:
Coding audits of Professional Coding staff in accordance with regulatory requirements, official coding guidelines, and Network audit standards.
Reviews and validates coded medical records to assess coding accuracy, documentation integrity, compliance risk, and reimbursement impact related to ICD-10-CM/PCS, CPT/HCPCS, DRG/APC assignment, modifiers, and applicable payment methodologies.
Analyzes audit results to identify trends, patterns, and areas of risk or opportunity, including recurring errors, documentation gaps, and compliance vulnerabilities across the hospital system.
Develops audit summaries, reports, and tracking tools to communicate findings, monitor improvement over time, and support leadership review and decision-making.
Provides targeted, audit-driven education and training to Professional Coding staff, including one-on-one feedback and department-level education based on validated audit findings.
Collaborates with Coding Management and Compliance to recommend corrective actions, process improvements, and risk mitigation strategies based on audit outcomes.
Supports onboarding and ongoing education of coding staff by contributing audit-based insights, educational materials, and coding guidance aligned with official standards and Network expectations.
Participates in external audit activities, including preparation, review, validation of findings, and assistance with response development, in collaboration with Coding Management and Compliance.
Promotes accurate, compliant documentation and coding practices through consistent application of coding principles, official guidelines, and regulatory requirements.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting up to 7 hours per day, 3 hours at a time. Repetitive arm/finger use for retrieving/viewing computerized patient medical records and abstracting information. Extended periods of vision use for reviewing computerized patient records, abstracting of patient information, approximately 7 hours per day, hours at a time. Hearing as it relates to normal conversation. Seeing as it relates to general vision, peripheral vision and visual monotony. Occasionally may be required to use upper extremities to lift up to 10 lbs.; stoop, bend, or reach to retrieve resource materials and/or paper records in accordance with downtime policy; or use wheel cart.
EDUCATION:
Must maintain and be credentialed in at least ONE of the following AHIMA and/or AAPC recognized Professional Coding Certifications: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Professional Auditor (CPMA); Certified Professional Coder (CPC); Certified); Certified Coding Specialist (CCS); In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems. Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS/CPT Official Guidelines, Outpatient Prospective Payment System and Coding Clinic References. Current working knowledge of encoder/grouper. Strong analytical and communication skills.
TRAINING AND EXPERIENCE:
5 years of coding experience required. Experience in auditing education techniques and methods preferred, but not required.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!