HIM Audit and Educ Specialist / PB Coding

Hartford HealthCare Corp.•Farmington, CT

5d•Onsite

About The Position

The Audit & Education Specialist develops and implements a comprehensive coding audit and education program consistent with regulatory, contractual, professional, and healthcare revenue cycle industry standards. The role supports documentation practices that comply with CMS requirements for evaluation and management, procedures, risk adjustment programs, and ICD-10 coding guidelines. The position reports to the Audit and Education Specialist Manager and requires on-site auditing and training. The specialist assesses revenue opportunities, executes provider audit and education plans with quality assurance, analyzes audit results, and prepares reports for leadership. The role develops educational materials and documentation templates, trains providers and staff, researches regulatory and professional guidance, identifies coding and documentation issues, supports process improvements for Medicare Risk Adjustment, and builds partnerships with providers to improve documentation and diagnosis coding. It also includes individualized physician education, performance tracking, and assessing the outcomes of 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.
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 complete confidentiality of patient health information.
Reliable transportation, insurance, and a valid driver's license.
Ability to work in a fast-paced business environment, handle 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.
CPMA certification.
Bachelor's degree.
CRC certification; candidates who are not CRC qualified are expected to obtain the qualification within the first four to six months of employment.
Experience with diagnosis coding nuances and risk adjustment programs.
Experience in an educational or training role.
Knowledge of business systems such as Epic.

Responsibilities

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