Professional Coding Auditor, Educator

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Conduct research, gather, and evaluate information that aligns with organizational goals.

• Recognize opportunities, formulate solutions, and guide issues through to resolution.

• Collaborate on initiatives aimed at enhancing program efficiency and improving patient experience.

• Prepare and distribute analytical reports.

• Utilize various system applications to perform analyses, generate reports, and create educational materials.

• Investigate and compile information for ad-hoc operational projects and initiatives.

• Synthesize and analyze data, create visual trend presentations, and propose practical solutions.

• Define and showcase progress, ROI, and operational impacts through program data and metrics.

• Offer technical expertise in coding and documentation review for complex services, including surgical procedure code selection and high-acuity services.

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

• Examine documentation and coding patterns to pinpoint compliance, revenue integrity, and regulatory risks.

• Provide constructive feedback to providers, coders, and leadership to enhance documentation quality and coding precision.

• Design and deliver focused education and training based on audit outcomes, regulatory updates, and identified knowledge gaps.

• Train and integrate new audit and education colleagues and providers.

• Maintain a minimum accuracy rate of 95% in coding audits and fulfill the audit and education work plan.

⛳️ Requirements

• Associate degree in Health Information Management or a related discipline, or an equivalent combination of education and experience.

• Comprehensive understanding of ICD-10, HCPCS, CPT, and HCC guidelines.

• Familiarity with medical terminology, Medicare and Medicaid regulatory guidelines, and payer policies.

• At least five (5) years of professional coding experience, including surgical procedures.

• A minimum of two (2) years in auditing and/or educational roles.

• Must hold one of the following certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Professional Certification (CPC).

• Bachelor’s degree in health information management or a related healthcare field is preferred.

• Desired experience in auditing and provider education.

• Preferred credentials include Certified Professional Medical Auditor (CPMA), Certified Risk Coder (CRC), or Clinical Documentation Expert – Outpatient (CDEO).

• Proficient in using various system applications and computer technologies.

• Must be able to uphold confidentiality, safety, and compliance with relevant laws and policies.

🏝️ Benefits

• Commitment to Equal Opportunity Employment.

• A workplace driven by mission and values.

• Opportunities for professional development through audit education and training responsibilities.