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Professional Fee Coding Auditor Claims Edit Specialist (Full-Time, Day)

NorthBay Health • Fairfield, CA, US • published 2026-09-26 09:51:26.184683

Description

At NorthBay Health the Professional Fee Coding Auditor is responsible for auditing professional fee coding across all service lines (Ambulatory/Hospitalist, Surgery, and Emergency Medicine), resolving pre‑billing coding edits, and reviewing post‑billing coding‑related denials. This role ensures coding accuracy, documentation integrity, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer‑specific rules. The position supports coding quality improvement, identifies trends, provides coder feedback and physician education based on audit and edit findings, and partners with leadership to strengthen coding workflows across the organization. **PRIMARY JOB DUTIES** **Audit Responsibilities** * Performs routine and targeted professional fee coding audits across all service lines: Ambulatory/Hospitalist (including Urgent Care and Pools), Surgery, and ED ProFee. * Reviews documentation for completeness, accuracy, and compliance with CPT, HCPCS, ICD‑10‑CM, and payer policies. * Identifies trends, patterns, and recurring issues affecting coding quality or compliance. * Prepares audit summaries and provides clear, constructive feedback to coders and leadership. * Assists in developing coder and ...

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