Director of Documentation Integrity and Coding

The goal is this position is to educate providers on proper use of CPT codes, ICD10 codes, 
modifiers and audit activities related to health plan operations, risk adjustment, payer audits and 
regulatory requirements. This role ensures accurate medical coding, documentation integrity, and 
adherence to federal, state, and payer-specific guidelines. The ideal candidate will possess 
advanced CPC coding expertise, strong analytical skills, and extensive experience 
supporting compliance initiatives within a managed care or health plan environment.
This is a full-time position, on site, 5 days a week.
Responsibilities:
• Serve as subject matter expert on CPT, HCPCS, ICD10 and modifier coding for physicians 
and coders.
• Ensure provider documentation and coding practices comply with CMS, Medicare, 
Medicaid, commercial payer, and applicable federal and state regulatory requirements. 
• Conduct coding compliance audits to identify documentation deficiencies, coding accuracy, 
billing compliance risks, and potential overpayments or underpayments.
• Contribute to the development and maintenance of coding policies and procedures.
• Create audit protocols and conduct audits by partnering, Revenue Cycle, Clinical Operations, 
and Medical Leadership to develop and implement educational plans resulting from coding 
audits.
• Assist in responding to payer audit requests, documentation reviews, and coding-related 
appeals.
• Participate in enterprise compliance initiatives related to billing integrity, fraud, waste and 
abuse (FWA) prevention, and revenue integrity.
• Establish relationships with clinicians, staff and management team.
• Provide training, education and reference materials to coders and providers.
• Prepare weekly and monthly reports documenting audit findings, action plan and results.
Required Qualifications
• Minimum of 5 years of physician coding, coding compliance, or revenue integrity 
experience.
• Certified Professional Coder or Certified Coding Specialist.
• Ability to communicate and educate physicians and midlevel providers, clinical staff, 
managers, directors and other staff.
• Comprehensive knowledge of CMS regulations, OIG Compliance Program Guidance, 
Medicare documentation requirements, Evaluation & Management (E/M) guidelines, HCC 
Risk Adjustment, NCCI edits, LCDs/NCDs, and payer reimbursement policies.
• Experience conducting provider coding audits, documentation reviews, and compliance 
education.
• Strong understanding of fraud, waste, and abuse prevention, medical necessity requirements, 
and documentation integrity.
• Experience working with eClinicalWorks (eCW) or comparable electronic health record 
systems preferred.
• Ability to interpret federal, state, Medicare, Medicaid, and commercial payer coding and 
billing regulations.
• Proficient use of Microsoft Office applications.
• Excellent verbal and written communication skills.