Professional Billing Auditor, Coding Educator & Compliance Spec.

Provider centered. Patient focused. Built for what healthcare should be.

We are looking for a dedicated Professional Billing Auditor, Coding Educator & Compliance Specialist who supports our mission through adhering to and perpetuating coding best practices across the clinic organization. This role will be responsible for varying levels of risk adjustment, regulatory compliance and HCC diagnoses.

Position Summary

The Professional Billing Auditor, Coding Educator & Compliance Specialist is responsible for ensuring the accuracy, integrity, compliance, and optimization of professional billing and coding practices across a growing network of primary care practices. This role conducts coding, documentation, and billing audits; evaluates compliance with CMS, Medicare, and commercial payer requirements; provides education to providers and staff; and oversees the quality and performance of AI-assisted coding workflows.

As a key resource, this position validates the alignment of provider documentation, coding outcomes, and AI-generated recommendations to ensure accurate reimbursement, regulatory compliance, and continuous process improvement.

Key Responsibilities

• Conduct retrospective audits of professional fee claims, including Evaluation & Management (E/M) services, preventive medicine services, Medicare Annual Wellness Visits, chronic care management (CCM), transitional care management (TCM), telehealth, and procedures.
• Validate the accuracy and compliance of AI-generated coding, charge capture, and billing recommendations.
• Review provider documentation against AI-coded claims to ensure coding accuracy, medical necessity, and regulatory compliance.
• Ensure compliance with CMS regulations, Medicare billing requirements, NCCI edits, LCDs, NCDs, OIG guidance, and commercial payer policies.
• Identify patterns in coding discrepancies, documentation deficiencies, AI performance issues, and compliance risks; recommend corrective actions and workflow improvements.
• Prepare audit reports, risk assessments, and corrective action recommendations for leadership, providers, and operational stakeholders.
• Support internal compliance initiatives and external audits conducted by CMS, Medicare contractors, commercial payers, and regulatory agencies.

• Audit AI-assisted coding outputs and provider documentation to validate CPT, HCPCS, and ICD-10-CM coding accuracy and medical necessity to ensure consistency, accuracy, and compliance. 
• Assess E/M code selection and documentation support using current AMA and CMS guidelines.
• Validate appropriate use of modifiers, preventive service codes, time-based services, and payer-specific billing requirements.
• Ensure documentation supports billed services and complies with applicable coding and reimbursement standards.

• Develop and deliver provider and staff education based on audit findings, coding trends, documentation deficiencies, and compliance risks.
• Provide training on CPT, HCPCS, ICD-10-CM, E/M guidelines, preventive services, Medicare wellness services, chronic care management, and payer-specific requirements.
• Educate providers on documentation best practices to improve coding accuracy and optimize AI-assisted coding performance.
• Create and maintain educational materials, coding resources, and RCM Coding and compliance policies and reference tools.
• Support onboarding and ongoing education for providers, coders, and revenue cycle staff.
• Serve as a subject matter expert for coding, documentation, billing compliance, and AI-assisted coding inquiries.

Specialized Knowledge and Skills

• Minimum five (5) years of professional auditing and compliance knowledge
• Minimum five (5) years of primary care or outpatient physician coding experience.
• Expert knowledge of CPT, HCPCS, ICD-10-CM, Medicare billing requirements, and professional fee coding.
• Expertise in E/M coding guidelines, Preventive Medicine Services, Medicare Annual Wellness Visits, CCM, TCM and Telehealth services.
• Strong knowledge of value-based care models and Accountable Care Organizations (ACOs).
• Thorough understanding of CMS regulations, OIG compliance guidance, HIPAA requirements, and payer policies.
• Strong analytical, organizational, written, and verbal communication skills.
• Proficiency in using electronic health record (EHR) systems, Microsoft Office applications (including PowerPoint) and data analysis tools.
• Ability to work independently, manage multiple priorities, and respond to ad hoc audit requests.
• Strong understanding of primary care coding and documentation requirements.
• Ability to identify compliance risks and drive improvement through education and process optimization.
• Experience integrating auditing, provider education, compliance oversight, and technology-enabled workflows.
• Ability to analyze coding, documentation, and AI performance trends to improve accuracy and reduce compliance risk.
• Strong interpersonal skills with the ability to influence provider documentation practices and collaborate across clinical, operational, compliance, and technology teams. 

Education

• CPMA (Certified Professional Medical Auditor) certification.
• Additional certifications such as CPC, CCS-P, RHIT, or RHIA.
• Five (5) or more years of dedicated coding and auditing experience.
• Experience working with AI-assisted coding, clinical documentation technologies.
• Experience with Athenahealth and primary care practice operations.
• Familiarity with AI governance, validation methodologies, and technology-enabled revenue cycle processes.

Why you’ll Love Working Here

We take care of our team so they can take care of patients. Benefits include:

What We Value

Trust. Ownership (Together). Compassion. Relentless Progress. These values shape how we show up for patients — and for each other.

If you’re ready to grow, make an impact, and be part of a connected care team, we’d love to connect.

Bookmark Medical is committed to a workplace that supports and sustains inclusion and belonging. Bookmark Medical does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, national origin, age, physical or mental disability, pregnancy, childbirth or related medical conditions, military service obligations, citizenship, sexual orientation, genetic information, or any other characteristic protected by applicable local, state, or federal law.