Professional Coding Auditor, Educator

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

📋 Description

• Conduct research, gather, and analyze relevant information.

• Recognize opportunities, devise solutions, and guide through implementation.

• Engage in performance enhancement initiatives pertaining to program efficiency and patient satisfaction.

• Distribute analytical reports effectively.

• 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, providing detailed summaries and graphical representations that illustrate trends.

• Propose practical options or solutions while taking into account business strategies and leadership decision-making.

• Utilize program and operational data to define and showcase progress, ROI, and impacts.

• Examine coding and documentation for complex services, including surgical procedure code selection and high-acuity services.

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

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

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

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

• Train and onboard new colleagues in auditing and education as well as providers.

• Comply with coding quality and productivity standards as established by Revenue Excellence.

• Fulfill the audit and education workplan as defined by the Service Area Manager of Coding Audit and Education.

⛳️ Requirements

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

• In-depth knowledge of ICD-10, HCPCS, CPT, and HCC guidelines.

• Familiarity with medical terminology.

• Understanding of regulatory guidelines, including Medicare and Medicaid.

• Awareness of payer policies.

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

• At least two (2) years of experience in auditing and/or education.

• RHIT, RHIA, CCS, or CPC certification is required.

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

• CPMA, CRC, or CDEO credentials are preferred.

• Capability to maintain a coding accuracy of 95% or higher.

• Ability to complete the audit and education workplan.

• Proficiency in using multiple system applications and computer technology.

• Compliance with applicable laws, regulations, policies, procedures, guidelines, and the Code of Conduct.

• Ability to occasionally lift a maximum of 30 pounds unassisted.

• Capacity to provide assistance in emergency situations.

🏝️ Benefits

• Equal Opportunity Employer.

• Culture focused on person-centered care.

• Personal protective equipment (PPE) provided.

• Temperature-controlled and well-lit indoor working environment.