HIM Audit and Educ Specialist / PB Coding

Hartford Healthcare•Farmington, CT

About The Position

The Audit and Education Specialist develops and implements a comprehensive coding audit and education program aligned with regulatory, contractual, professional, and healthcare revenue-cycle standards. The specialist supports documentation practices that comply with CMS requirements for evaluation and management, procedures, risk adjustment programs, and ICD-10 coding guidelines. The role reports to the Manager of Audit and Education and requires on-site auditing and training.

Requirements

Medical coding credential required: CPC, CCS-P, or CCS.
At least five years of work experience with CPT, HCPCS, and ICD-10 coding conventions.
Experience interpreting Medicare, Medicaid, and third-party billing and compliance regulations.
Experience with claim submission requirements.
Experience analyzing data and review results, and educating clinical providers and coders effectively.
Strong communication skills, including the ability to navigate challenging conversations and train providers in large and small groups.
Ability to influence providers to improve documentation.
Experience in project management and follow-up.
Progressively responsible role with leadership.
Commitment to maintaining the confidentiality of patient health information.
Reliable transportation, insurance, and a valid driver's license.
Ability to work effectively in a fast-paced business environment, manage multiple priorities, communicate effectively in writing and verbally, and exercise appropriate judgment.

Nice To Haves

Experience working with CMS, health insurers, and medical providers.
At least seven years of work experience with CPT, HCPCS, and ICD-10 coding.
CPMA certification.
A baccalaureate degree.
CRC certification; candidates who are not CRC-qualified are expected to obtain the qualification within the first 4–6 months of employment.
Experience with diagnosis-coding nuances and risk adjustment programs.
Experience in an educational or training role.
Experience with Word, Excel, and PowerPoint.
Knowledge of business systems such as Epic.

Responsibilities

Assess revenue opportunities and carry out the professional audit work plan, including provider audits, education, and quality assurance.
Compile and prepare complex reports for key leadership stakeholders.
Analyze audit results, develop educational materials, and train providers and staff on coding updates and quality assurance.
Create documentation templates tailored to specialties or clients, and train users on them to support appropriate documentation of services.
Research regulatory guidance and professional and peer organization practices, policies, and guidelines to keep the organization current.
Identify recurring documentation and coding issues and process improvements, and communicate audit requirements through memos and other documentation.
Identify process improvements to capture Medicare Risk Adjustment data and help providers code to the appropriate level of specificity.
Develop relationships, programs, and processes with providers to improve diagnosis documentation and coding accuracy.
Develop knowledge-transfer strategies and assess training outcomes and effectiveness.
Provide individualized physician education and track performance over time.
Use face-to-face communication to address issues as they arise.