New

HIM Professional Coding Auditor Lead - FT - Days - HIMS - Medical Records @ MV

El Camino Hospital
United States, California, Mountain View
2500 Grant Road (Show on map)
Aug 13, 2025
El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen. Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for. FTE 1 Scheduled Bi-Weekly Hours 80 Work Shift Day: 8 hours Job Description The HIM Professional Coding Auditor Lead serves as a subject matter expert in advanced elements of auditing of physician and clinician base charging and billing with extensive knowledge in ICD-10-CM diagnosis, CPT procedural assignment, and HCPCS Level II coding systems. Maintains extensive knowledge of CMS coverage policies and conducts research in the national database applications to support inpatient and outpatient services. Supports El Camino Health professional fee charges with quality reviews ensuring billed services meet standards of reporting. HIM Professional Coding Auditor Lead core duties: Monitors un-billed, claim edit, and denied claim reviews ensuring revenue metrics do not exceed claims submissions. Submits charge-master CPT and HCPCS procedures requiring charges with the use of revenue integrity applications and notification to team members in releasing charges. Leads educational sessions with the coding team by conducting research in various regulatory sites and coding guidelines in creating educational content for both clinicians and coding team members in reducing claim and payer denials. Extracts and uploads audited data from third-party vendors and coordinates other team members assignment in maintaining all monthly audits are completed in a timely manner. Primary educator with onsite and electronic format meetings for new and existing providers/clinicians. Supports both facility and professional lines with coding reviews and assist with coding facility backlogs as needed. Performs reviews of payer denials and track trends in providing monthly providers/clinicians education. Performs training of new and existing coding staff. Conducts internal and external auditing of coding staff team members by providing educational monthly reporting to reduce claim denials for ECHMN medical documentation by updating ECH Professional Coding Guidelines Performed other duties as assigned by the Coding management. Qualifications Five (5) years' experience with physician base billing including inpatient reporting. Advanced knowledge of CMS coverage policies and national coding edits. Proficiency in computer usage including analytical Microsoft tools i.e., spreadsheets, databases, presentation and word processing applications. Advanced knowledge of federal, state and private payer regulations. License/Certification/Registration Requirements Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required Certified Professional Medical Auditor) CPMA preferred Ages of Patients Served This position will serve all age groups. Salary Range: $58.29 - $87.44 USD Hourly The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation. Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America) An Equal Opportunity Employer: El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.