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Physician Coding Review Specialist

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Advocate Health Care

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Location:
United States

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

26.55 - 39.85 USD / Hour
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Job Responsibility:

  • Review assigned codes, which most accurately describe each documented diagnosis and/ or procedure according to established CPT, HCPCS, and ICD-10-CM coding guidelines along with modifier usage and medical terminology
  • Monitor all coding accuracy at various levels of detail and maintain coding quality as needed
  • Track coding issues and review coding inaccuracies to highlight areas of improvement
  • Report or resolve escalated issues as necessary
  • Responsible for reviewing Clinician documentation and billed codes for Medical Group physicians and non-physician clinicians
  • Review of medical records in collaboration with key stakeholders such as Internal Audit, Compliance, and Clinic Operations
  • Responsible for completing all certified coder quality reviews
  • Working in collaboration with Coding Production Leads and Supervisors
  • Follows the prospective and/or retrospective review plan to sample employed Clinician's medical record documentation in comparison to services selected for billing, based on best practice methodologies which will be presented and reviewed with Clinicians to provide feedback on proper coding and documentation practices
  • Follows the necessary schedules for team assignments of documentation/coding accuracy
  • Conducts required, timely reviews per the established Clinician Documentation Review Plan and generates summary reports for Professional Coding leadership and Provider Compliance Committee
  • Develops mechanisms to identify specific quality issues for each Clinician to allow for focused follow-up reviews to identify improvement/correction of those elements for which the Clinician has received an education
  • Ensures compliance with the system Clinician Documentation Review Plan escalation process for any Clinician who is not successful in meeting the minimum acceptable thresholds
  • Provides feedback when documentation issues are identified that need improvement
  • Conducts focused reviews requested by the Compliance department, clinic administration, and Professional Coding leadership
  • Utilizes monitoring tools or other applications to track and report the progress of the Clinician Documentation & Coding Accuracy Plan and for the evaluation of coding quality standards
  • Identifies, evaluates and acts to resolve any barriers to meeting documentation standards
  • Provides education/feedback to the department Educators and Coding Liaisons
  • Maintains coding quality standardized reporting mechanisms
  • Provides standardized statistical reports of coding quality information to Professional Coding leadership and other appropriate parties
  • Identifies and trends coding quality issues/concerns
  • Recommends coding accuracy improvement strategies, including continued education and/or training plans
  • Provides feedback regarding coding guidelines, coding protocols/procedures, and system edits to continually improve coding processes and ultimately the overall coding quality program
  • Conducts scheduled and ad hoc coding quality reviews
  • Conducts regularly scheduled reviews of encounters where coding has been changed or deleted by Coding team members to ensure accuracy and provide education recommendations
  • Reviews abstracted and coded encounters for coding accuracy and completeness
  • Provides feedback on billing system edits as applicable
  • Provides results to Physician Coding leadership and education recommendations as needed
  • Collaborates with interdepartmental or cross-functional teams for assigned projects and provides departments with coding issues and updates to be shared with Clinicians
  • Utilizes chart review results to provide data-driven feedback to clinicians and management to improve coding accuracy and identify opportunities for improvement and re-training
  • Maintains up-to-date knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards

Requirements:

  • Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA)
  • Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA)
  • Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
  • Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
  • Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC)
  • Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC)
  • Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC)
  • Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist
  • Typically requires 5 years of experience in expert-level professional coding and at least 3 years of experience in the education of clinicians in physician revenue cycle processes, health information workflows, and medical record auditing experience
  • Advanced knowledge of ICD, CPT, and HCPCS coding guidelines
  • Advanced knowledge of medical terminology, anatomy, and physiology
  • Advanced ability to identify coding quality issues/concerns and provide recommendations for improvement
  • Advanced ability to analyze trends and data and display them in a statistical reporting format
  • Advanced organization and communication (verbal and written) skills
  • Advanced ability to effectively train others through oral and/or written methods
  • Advanced organization, prioritization, and reading comprehension skills
  • Advanced analytical skills, with high attention to detail
  • Intermediate computer skills including the use of Microsoft Office, email, and exposure or experience with electronic coding systems or applications
  • Advanced knowledge of care delivery documentation systems and related medical record documents
  • Advanced interpersonal communication skills (oral and written) necessary to collaborate with Physicians, other clinicians, and Professional Coding Department team members and leadership
  • Ability to work independently and exercise independent judgment and decision-making
  • Ability to meet deadlines while working in a fast-paced environment
  • Ability to take initiative and work collaboratively with others
What we offer:
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

Additional Information:

Job Posted:
January 29, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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  • Critical Thinking & Analytical Skills: Highly proficient in problem-solving and analytical thinking with strong attention to detail.
  • Interpersonal Communication: Excellent verbal and written communication skills, with the ability to educate and collaborate effectively with physicians, APCs, clinical leadership, and coding teams.
  • Advanced Computer Skills: Proficiency in Microsoft Office Suite, electronic coding applications, and email communication.
  • Organizational & Prioritization Skills: Ability to efficiently manage multiple tasks, set priorities, and meet deadlines in a fast-paced environment.
Job Responsibility
Job Responsibility
  • Deliver proactive coding education through newsletters, scorecards, and presentations, covering CPT (E&M, modifiers), ICD-10-CM, HCPCS, Risk Adjustment, payer requirements, and rejection resolutions.
  • Lead onboarding and compliance training for all employed Physicians/APPs, including Locum Tenens, residents, and students, ensuring documentation accuracy from the start.
  • Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks, escalating non-coding issues to appropriate teams.
  • Serve as the primary contact for coding inquiries, coordinating with internal teams to resolve complex issues such as NCCI bundling and high-complexity charge edits.
  • Monitor Epic work queues (charge review, follow-up, claim edit) to ensure timely and accurate charge submissions and reduce claim denials.
  • Collaborate across departments—including CMOs, Clinical Informatics, Risk Adjustment, and Population Health—to enhance documentation practices and system optimization.
  • Participate in specialty and department meetings, identifying trends and delivering targeted education to improve coding and documentation accuracy.
  • Refine Epic documentation tools, including templates, order entries, diagnosis lists, and SmartSets/SmartPhrases, to improve efficiency and accuracy.
  • Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA’s Standards of Ethical Coding, while maintaining expert knowledge of evolving policies.
  • Promote a culture of ethical coding and continuous improvement, supporting clinicians with timely updates, feedback, and education to ensure accurate reimbursement and compliance.
What we offer
What we offer
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program
  • Fulltime
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