[Remote] Professional Billing Auditor, Coding Educator & Compliance Spec.

Note: The job is a remote job and is open to candidates in USA. Bookmark Medical is hiring a Professional Billing Auditor, Coding Educator & Compliance Specialist to ensure accurate, compliant professional billing and coding across its primary care practices. The role audits documentation, claims, and AI-assisted coding, supports compliance initiatives, and educates providers and staff to improve coding accuracy and workflows.

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

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
• CPMA (Certified Professional Medical Auditor) certification
• Five (5) or more years of dedicated coding and auditing experience
• Additional certifications such as CPC, CCS-P, RHIT, or RHIA
• 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

Benefits

• Medical, dental, and vision coverage
• Company-funded HSA
• Exclusive healthcare discounts
• 401(k) with company match
• Company-paid life insurance
• Flexible time off
• Vacation Exchange Program
• Medical Assistant Certification Reimbursement

Company Overview