Professional Fee Coding Auditor Claims Edit Specialist (On-Site, Hybrid, Remote)

Professional Fee Coding Auditor

Work Location Requirement: This position may be performed onsite or remotely; however, onsite work is preferred based on business needs. Preference will be given to qualified candidates who are able to work onsite and are located within a reasonable commuting distance.

Remote Work Eligibility: This position is open to candidates located within the continental United States. Due to state-specific employment requirements and workers' compensation regulations, we are unable to support remote work arrangements in the following locations: Washington, Ohio, Wyoming, North Dakota, Puerto Rico, and the U.S. Virgin Islands.

At Northbay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre-billing coding edits, and reviewing post-billing coding-related denials.

This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD-10-CM, and payer-specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization.

Qualifications

Education:

• High School diploma preferred; Associate's or Bachelor's preferred.

Certification:

• Requires one of the following credentials: CPC, CCS-P, or CPMA.
• CRC (Certified Risk Adjustment Coder) preferred in addition to one of the certifications above.

Experience:

• Minimum 5 years of professional fee coding experience across multiple specialties.
• Minimum 3 years of prior auditing and edit-resolution experience is required.
• Strong knowledge of anatomy, physiology, medical terminology, disease processes, and official coding guidelines.

Skills:

• Requires strong analytical skills, deep understanding of clinical documentation, and the ability to work independently with high accuracy in any EHR or coding/billing platform.
• Proficiency with EHRs, encoders (e.g., 3M), and Microsoft Office.

Interpersonal Skills:

• Communicates effectively with coders, providers, and cross-functional teams.
• Maintains professionalism under deadlines and shifting priorities.

Standards of Performance:

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort:

• Ability to sit for extended periods.
• Ability to lift/push/pull up to 5 lbs.
• Frequent keyboarding and sustained concentration.

Compensation is based on CA salary range, Max rate is commensurate of 20+ years experience in Pro Fee Coding Auditor role.