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Day - 08 Hour (United States of America)
This is a Stanford Health Care job.
A Brief Overview
The Professional Coding Audit and Educator serves as a senior-level subject matter expert responsible for evaluating, designing, and continuously improving the effectiveness of professional coding quality and compliance controls across the organization. This role assesses the adequacy and effectiveness of operational, regulatory, and compliance controls to ensure professional coding practices align with federal and state regulations, CMS (Centers for Medicare & Medicaid Services), OIG (Office of Inspector General) guidance, AMA CPT and ICD-10-CM Official Coding Guidelines, and applicable payer policies.
This position leads and executes professional coding quality audits using standardized methodologies and scoring frameworks to evaluate coding accuracy, documentation support, and compliance risk. The role establishes consistent audit approaches, ensures audit integrity and defensibility, and standardizes reporting structures to support organizational monitoring, regulatory readiness, and continuous improvement initiatives.
The Professional Coding Audit and Educator partners cross-functionally with Professional Coding Leadership, Revenue Integrity, Compliance, Clinical Departments, and Operational Leaders to translate audit findings into actionable education, process improvement initiatives, and system optimization opportunities. The role supports organizational audit strategies by assisting in identifying high-risk areas, new services, and regulatory changes requiring targeted review and education.
Locations
Stanford Health Care
What you will do
Conduct professional coding quality audits across multiple specialties and service lines to evaluate coding accuracy, documentation support, modifier usage, and compliance with CMS, OIG, AMA CPT, ICD-10-CM Official Coding Guidelines, and payer-specific requirements.
Apply standardized audit methodologies and scoring frameworks to ensure consistent, objective evaluation of coding performance and defensible audit results.
Analyze audit findings to identify trends, systemic issues, and emerging risk areas impacting compliance, reimbursement accuracy, or operational workflows.
Develop and deliver targeted education to coding staff, School of Medicine Departments and Divisions, and clinical stakeholders based on audit outcomes, regulatory updates, and identified knowledge gaps.
Serve as a subject matter expert for interpretation and application of complex professional coding guidelines, providing guidance on coding scenarios, regulatory requirements, and documentation expectations.
Perform risk-based assessments to prioritize audit focus areas, including new services, high-risk procedures, and areas of regulatory or operational change.
Partner with Coding Leadership, Compliance, Revenue Integrity, and operational stakeholders to translate audit findings into process improvements, workflow optimization, and system enhancement recommendations.
Support organizational coding accuracy and compliance initiatives by monitoring performance against established accuracy benchmarks and recommending corrective action plans when necessary.
Prepare and present audit results, trend analyses, and education outcomes to leadership and operational teams to support transparency, accountability, and continuous improvement.
Maintain current knowledge of regulatory changes, coding updates, payer policies, and industry best practices to ensure audit methodologies and education content remain current and compliant.
Participate in internal and external audit preparation activities, supporting organizational readiness.
Contribute to the development and maintenance of audit tools, education materials, and standardized documentation to promote consistency across the professional coding program.
Researches, interprets, and communicates federal, state, and payer-specific documentation, coding rules, and regulatory requirements; maintains current knowledge of Medicare, Medi-Cal, and commercial payer policies, ICD-10-CM and CPT coding updates, Coding Clinic and CPT Assistant guidance; and serves as a subject matter expert and authoritative resource to coding staff, revenue integrity, and operational stakeholders on the application of professional coding standards and regulatory expectations.
Education Qualifications
High School Diploma or GED equivalent Required
Associate’s Degree Preferred
Experience Qualifications
Eight (8) years of experience to include five (5) years of multi-specialty professional coding and three (3) years of auditing & education Required
Experience in Epic coding workflows Required
Experience with an auditing software i.e. Solventum CodeAudit or MDAudit Preferred
Required Knowledge, Skills and Abilities
Advanced knowledge of professional coding principles, including ICD-10-CM, CPT, and HCPCS coding conventions, modifier application, and documentation requirements across multiple specialties.
Strong knowledge of federal and state regulations, including CMS, OIG, Medicare, Medi-Cal, NCCI edits, and third-party payer policies impacting professional coding compliance and reimbursement.
Ability to interpret complex regulatory and coding guidance and translate requirements into operational practice, audit methodology, and education.
Strong analytical skills with the ability to evaluate complex coding scenarios, identify trends or compliance risks, and develop practical, compliant solutions.
Demonstrated ability to exercise independent judgment in risk assessment, prioritization of audit activities, and resolution of complex coding issues.
Effective written and verbal communication skills, including the ability to present audit findings, summarize data, and communicate recommendations to coding staff, leadership, and operational stakeholders.
Knowledge of electronic health record systems and coding workflows as applied to professional coding review and audit activities.
Ability to interpret clinical documentation and abstract relevant information from medical records to support accurate coding and compliance evaluation.
Strong organizational and project management skills with the ability to manage multiple priorities in a dynamic regulatory environment.
Knowledge of medical terminology, anatomy and physiology, and disease processes relevant to professional coding.
Commitment to ethical coding standards consistent with AHIMA and/or AAPC professional guidelines.
Licenses and Certifications
CPC - Certified Professional Coder required Upon Hire or
CCS - Certified Coding Specialist required Upon Hire or
CCS-P - Certified Coding Specialist – Physician-based required Upon Hire or
RHIT - Registered Health Information Technician required Upon Hire or
RHIA - Registered Health Information Administrator required Upon Hire or
These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
Know Me: Anticipate my needs and status to deliver effective care
Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $59.21 - $78.43 per hourThe salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.