About SunStone Consulting
At SunStone Consulting, we help healthcare organizations across the United States navigate today's increasingly complex reimbursement, regulatory, compliance, and revenue cycle environment. Our clients include hospitals, health systems, physician practices, and other healthcare providers who rely on our expertise to improve financial performance while maintaining the highest standards of compliance.
We are seeking a highly skilled clinical professional with deep expertise in professional and outpatient facility documentation, coding, and billing audits. If you thrive in a workplace culture that values open communication, collaboration, and continuous growth, this role offers an exciting opportunity to apply your clinical and coding knowledge in meaningful, high‑impact ways. You’ll work independently in a home‑office setting while contributing to a supportive, team‑based environment where problem‑solving and attention to detail are essential.
About the Role
As a Senior Clinical Specialist, you’ll serve as a key clinical and coding expert across a variety of revenue integrity audit and consulting engagements. Your work will directly influence documentation quality, compliance accuracy, and client education initiatives.
What You’ll Do
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Partner with management to develop audit approaches aligned with each client’s scope of services.
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Provide clinical oversight and coding support to consulting teams during documentation, coding, and billing reviews.
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Perform quality reviews of consultant findings and support Senior Managers in preparing clear, well‑referenced observations and recommendations.
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Apply comprehensive knowledge of Medicare/Medicaid regulations, Conditions of Participation, state healthcare rules, ICD‑10‑CM and CPT guidelines, AMA E/M guidance, NCCI edits, Coding Clinics, and other regulatory resources.
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Evaluate governmental and third‑party payer denials using LCDs, NCDs, CMS guidance, and payer‑specific rules.
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Conduct regulatory research and translate complex guidelines into clear, client‑friendly summaries.
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Prepare accurate, clinically credible work papers that support audit findings.
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Develop and deliver education for practitioners, clinical staff, allied health professionals, and coders on documentation and coding improvement opportunities.
What We’re Looking For
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Bachelor of Science in Nursing (BSN) and/or active RN license (other clinical degrees considered).
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At least one coding certification: CPC, COC, CCS, or CCA.
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10+ years of multi‑entity clinical, coding, or health information experience.
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Strong clinical knowledge of anatomy, physiology, and medical terminology.
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Excellent communication skills and the ability to collaborate effectively with managers, clients, and team members.
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Independent judgment, analytical thinking, accuracy, and strong decision‑making abilities.
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Proficiency with Microsoft Word, Excel, and email applications.
Why You’ll Love Working Here
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A culture built on transparency, teamwork, and professional growth.
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The autonomy to work independently while being supported by a highly skilled, collaborative team.
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Opportunities to expand your expertise across diverse client engagements.
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The chance to influence documentation quality and compliance at a meaningful scale.
