Professional Surgical Coding Auditor, Educator

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

📋 Description

• Conduct research, gather, analyze, synthesize, and summarize operational and coding information.

• Identify potential opportunities, devise solutions, and guide issues to resolution.

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

• Generate analytical reports featuring graphical trend presentations and practical recommendations.

• Offer technical and subject matter expertise for reviews of coding and documentation related to complex services.

• Examine surgical procedure code selection and high-acuity services.

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

• Analyze documentation and coding trends to pinpoint compliance, revenue integrity, and regulatory risks.

• Provide constructive feedback to providers, coders, and leadership.

• Develop and deliver educational training based on audit outcomes, regulatory changes, and identified knowledge gaps.

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

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

• Maintain a coding audit accuracy rate of 95% or higher and adhere to coding quality and productivity benchmarks.

⛳️ Requirements

• Associate degree in Health Information Management or a related field, or a comparable 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.

• Knowledge of payer policies.

• A minimum of five years of professional coding experience, including surgical procedures.

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

• Required credential: RHIT, RHIA, CCS, or CPC.

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

• Prior experience in auditing and provider education is preferred.

• Preferred credentials: CPMA, CRC, or CDEO.

• Capability to analyze data, documentation, and coding patterns.

• Ability to create reports and educational content.

• Ability to maintain a coding audit accuracy rate of 95% or higher.

• Ability to comply with relevant laws, regulations, policies, procedures, guidelines, and the Code of Conduct.

• Proficiency in using various system applications and computer technologies.

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

🏝️ Benefits

• Full-time employment.

• Commitment to being an Equal Opportunity Employer.

• A mission-driven, not-for-profit, faith-based healthcare organization.

• Community-focused employer with charity care and community benefit initiatives.