Note: The job is a remote job and is open to candidates in USA. Bookmark Medical is a healthcare organization focused on provider-centered, patient-focused care. The Professional Billing Auditor, Coding Educator & Compliance Specialist ensures accurate, compliant, and optimized professional billing and coding across primary care practices. The role conducts audits, evaluates AI-assisted coding workflows, supports regulatory compliance, and educates providers and staff.
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
- 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
- Additional certifications such as CPC, CCS-P, RHIT, or RHIA
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