Coding Compliance Auditor

About the role

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.

Responsibilities

• Review medical records and clinical documentation to ensure accurate, complete, and compliant coding in accordance with CMS regulations, federal and state guidelines (e.g., AHIMA, CMS, Medicaid), and payer-specific policies.
• Conduct routine and focused coding audits to identify documentation gaps, coding discrepancies, and areas of compliance risk.
• Collaborate with clinical leadership, revenue cycle, and compliance teams to resolve coding discrepancies and support accurate documentation practices.
• Communicate audit findings to providers and coding staff, providing actionable, audit-defensible recommendations and targeted education.
• Perform follow-up audits to validate remediation efforts and ensure sustained improvements in coding accuracy and compliance.
• Prepare written reports of findings to Compliance Leadership on charts reviewed per quarter, coding accuracy metrics, and identified risk areas.
• Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, providing guidance on complex or high-risk scenarios.
• What You Bring & How You Qualify
• First and foremost, you're passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support, they deserve.
• 5+ years of experience in professional fee coding and auditing, specializing in E/M and outpatient coding across a variety of clinical settings. Telehealth experience preferred.
• Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-10, DRG, etc.
• Prior coding or auditing experience in a Medicaid environment.
• Experience providing individual and group educational training to staff and providers using excellent verbal and written communication skills.
• Strong understanding of HEDIS measures and E/M coding, with the ability to evaluate documentation for quality measure compliance and audit-defensible coding practices.
• Bachelor's degree in healthcare management or related field preferred
• Familiarity with EMR software (e.g., Athena Health)
• CPC, or CCS; and CPMA required
• Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences.
• Demonstrate a strong commitment to coding compliance and regulatory standards while applying critical thinking and flexibility within a value-based care model, where coding scenarios may require nuanced interpretation beyond traditional fee-for-service guidelines.
• What We Offer (Benefits + Perks)
• We provide these additional benefits and perks:
• Competitive medical, dental, and vision insurance
• Healthcare and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, vested 100% from day one
• Employer-paid short and long-term disability
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid new parent leave
• Additional benefits to be detailed in offer
• What We Live By
• We're guided by our five core values:
• Our Values:
• Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future.
• Earn Trust

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