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Pacific Medical Centers Senior Coding Specialist - Risk & Audit Program - Uniformed Services Family Health Plan in Seattle, Washington


Find what you’re looking for in your career, at PacMed as a Senior Coding Specialist - Risk & Audit Program to the Uniformed Services Family Health Plan in Seattle, WA.

Responsible for achieving and maintaining provider coding accuracy and completeness at the levels required by the yearly Corporate Compliance Work Plan. Works directly with providers to educate and monitor their compliance to coding and reimbursement standards and to develop work plans for them to meet requirements. Conducts risk assessment audits. Reviews provider claim appeals for supporting documentation and renders a determination. Serves in a training capacity with providers and claim adjudicators. Responsible for remaining current on coding and compliance law and guidelines. Serves in a consultant capacity to the Compliance Officer regarding potential areas of improvement for the organization in meeting the requirements of the Compliance Plan.

In this position you will:

  • Provides education to contracted physicians/facilities, coding and PacMed CBS staff. Validates reimbursement to third parties for service through accurate CPT and ICD-10 coding; and ensures appropriate medical record documentation supports billed charges. Reviews documentation to ensure all appropriate signs, symptoms, chronic and acute conditions are supported and reported. Performs review and application of HCC codes when applicable.

  • Develops and performs integrity risk assessments and audits based upon process and documentation standards.

  • Assists the Compliance Officer in developing policies and procedures for the annual integrity audit program.

  • Works collaboratively with Coding Analysts and Claim Adjudicators. Shares knowledge and provides support with regard to audits, coding, documentation, and contracted physician/facility requirements and feedback.

  • Routinely completes coding and documentation audits based on compliance issues, OIG, and Defense Health Agency work plans and intuition. Audits medical chart documentation to ensure compliance with Federal guidelines regarding correct coding initiatives, fraud and abuse laws, and sanctions.


Required qualifications for this position include:

  • Three (3) years of health care experience in a physician group practice or other ambulatory care setting

  • Four (4) years of coding experience for a multi-specialty group

  • Two (2) years of experience conducting provider education and audits

  • One (1) year HCC hierarchal coding experience

  • CCS-P or CMC coding certification

  • ACS E/M or CEMA or CPMA CRC auditing certification within 6 (six) months of hire

  • Certified Professional Medical Auditor certification (CPMA) OR the Advanced Coding Specialist - Evaluation and Management (ACS E/M) Auditing certification OR the Certified Evaluation and Management (CEMA) certification within six months of hire.

Preferred qualifications for this position include:

  • Bachelor's Degree

Pacific Medical Center First Hill:

The patient population we care for is culturally and clinically diverse, creating a stimulating and rewarding workplace. Our strong team environment and mission allow us to provide friendly services that focus on the highest quality patient care. PacMed’s compensation and competitive benefits package will support and enhance a lifelong career.

The First Hill clinic is conveniently located east of I-5 in central Seattle. The clinic offers both primary care (Internal Medicine) and numerous areas of specialty care from Audiology to Women’s Health. Services offered at First Hill include ambulatory surgery, cardiovascular and echocardiography labs, infusion therapy, x-ray, onsite laboratory and pharmacy. Interpreter services are also available for our patients.

Seattle is the Pacific Northwest’s largest urban center (metro population 3.25 million), with world-class arts and entertainment, a robust economy and an outstanding school system. The city hugs magnificent Puget Sound and offers magnificent mountain views to the north, east and south. Seattleites are famously fond of the outdoors, fresh seafood and good coffee.

The First Hill clinic is part of Pacific Medical Centers’ expanding network of outpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties. Pacific Medical Centers is affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time, Pacific Medical Centers and Providence offer diverse locations, lifestyles and practice models. Find what you are looking for in your next practice opportunity with Pacific Medical Centers! Learn more at .

We offer a full comprehensive range of benefits — see our website for details —

Our Mission

Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.

About Us

Quality and respect. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 10 outpatient clinics across the Puget Sound region and more than 175 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”

Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Schedule: Full-time

Shift: Day

Job Category: Coding

Location: Washington-Seattle

Req ID: 257465