Professional Coding Auditor & Educator (REMOTE)

Employment Type:

Shift:

Description:

Purpose

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

Note: “patients” refers to patients, clients, residents, participants, customers, members

Essential Functions

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.

Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Maintains a working knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Functional Role (not inclusive of titles or advancement career progression)

• Provides high level technical competency & subject matter expertise analyzing coding and documentation review for complex services, including code selection of surgical procedures & assessment of high-acuity type services.

• Conducts comprehensive audits of professional coders and providers to ensure accuracy, compliance, and alignment with CPT, ICD 10, HCPCS, HCC and payer specific-specific guidelines.

• Analyze documentation and coding patterns to identify risks related to compliance, revenue integrity, and regulatory requirements.

• Provides clear, actionable feedback to providers, coders, and leadership to improve documentation quality and coding accuracy. .

• Develops and delivers targeted education and training programs based on audit findings, regulatory updates, and identified knowledge gaps.

• Provides training and onboarding to new audit and education of colleagues & providers.

• Adheres to coding quality & productivity standards as established by Revenue Excellence; Maintains accuracy of 95% or greater per coding audits; Responsible for completion of audit and education workplan as defined by the Service Area Manager of Coding Audit and Education.

Minimum Qualifications

Associate degree in Health Information Management or a related field or an equivalent combination of years of education & experience. Must possess extensive knowledge of ICD-10, HCPCS, CPT, and HCC guidelines, medical terminology, regulatory guidelines including Medicare and Medicaid, and payer polices.

Five (5) or more years of professional coding experience including surgical procedures and two (2) years of auditing and or education.

Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Profession Certification (CPC) is required.

Additional Qualifications (nice to have)

Bachelor's degree in health information management (HIM) or related healthcare field is preferred

Preferred prior experience in auditing and provider education.

Preferred credentials: Certified Professional Medical Auditor (CPMA), Certified Risk Coder (CRC), Clinical Documentation Expert - Outpatient (CDEO).

Physical & Mental Requirements & Working Conditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional

• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional

• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional

• Exposure to interruptions, shifting priorities & stressful situations. Frequent

• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous

• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent

• Perform manual dexterity activities & / or grasping / handling. Occasional

• Ability to climb, kneel, crouch & / or operate foot controls. Occasional

• Use a computer / other technology. Frequent

• Sit with the ability to vary / adjust physical position or activity. Continuous

• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous

• Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines. Continuous

• Ability to provide assistance in the event of an emergency. Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional

• Lift a maximum of 30 pounds unassisted. Occasional

• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional

• Encounter a clinical / patient facing / hands on interactive work environment. Occasional

• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous

• Work outdoors with variable external environmental conditions. Occasional

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.