Professional Coding Auditor & Educator (REMOTE)

Trinity Health•Livonia, MI

1d•Remote

About The Position

The Professional Coding Auditor & Educator applies specialized knowledge, research, data analysis, critical thinking, and problem-solving skills to support organizational objectives. The role serves as a peer influencer and may direct projects or project teams, while collaborating on performance improvement activities and distributing analytical reports. The position provides high-level technical expertise in coding and documentation review for complex services, including surgical procedure code selection and assessment of high-acuity services. It conducts comprehensive audits of professional coders and providers to assess accuracy, compliance, and alignment with CPT, ICD-10, HCPCS, HCC, and payer-specific guidelines. The auditor analyzes documentation and coding patterns for compliance, revenue integrity, and regulatory risks, and provides actionable feedback to providers, coders, and leaders. The role develops and delivers education based on audit findings, regulatory updates, and knowledge gaps, and provides onboarding and training to new audit and education colleagues and providers. It uses multiple system applications to analyze data, produce reports, and develop educational materials; synthesizes operational information into summaries and graphical presentations; and supports leadership decision-making. The position follows Revenue Excellence coding quality and productivity standards, maintains coding audit accuracy of 95% or greater, and completes the audit and education workplan defined by the Service Area Manager of Coding Audit and Education. The colleague is expected to follow applicable laws, regulations, organizational policies, compliance requirements, and safe work practices.

Requirements

Associate degree in Health Information Management or a related field, or an equivalent combination of education and experience.
Extensive knowledge of ICD-10, HCPCS, CPT, and HCC guidelines, medical terminology, Medicare and Medicaid regulatory guidelines, and payer policies.
Five or more years of professional coding experience, including surgical procedures.
Two years of auditing and/or education experience.
One of the following credentials is required: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Professional Certification (CPC).

Nice To Haves

Bachelor's degree in Health Information Management or a related healthcare field.
Prior experience in auditing and provider education.
Preferred credentials: Certified Professional Medical Auditor (CPMA), Certified Risk Coder (CRC), or Clinical Documentation Expert – Outpatient (CDEO).

Responsibilities

Research, collect, and analyze information; identify opportunities; develop solutions; and lead issues through resolution.
Collaborate on performance improvement activities and distribute analytical reports.
Use system applications to conduct analysis, create reports, and develop educational materials.
Compile and analyze data for operational projects and initiatives, including summaries and graphical presentations of trends, options, and solutions.
Conduct comprehensive audits of professional coders and providers for coding accuracy, compliance, and adherence to coding and payer guidelines.
Review complex coding and documentation, including surgical procedure code selection and high-acuity services.
Identify documentation and coding patterns that may create compliance, revenue integrity, or regulatory risks.
Provide actionable feedback to providers, coders, and leadership to improve documentation and coding accuracy.
Develop and deliver targeted education and training based on audit results, regulatory updates, and identified knowledge gaps.
Provide training and onboarding to new audit and education colleagues and providers.
Maintain coding audit accuracy of 95% or greater and meet Revenue Excellence quality and productivity standards.
Complete the audit and education workplan established by the Service Area Manager of Coding Audit and Education.
Maintain knowledge of and comply with applicable laws, regulations, organizational policies, compliance requirements, and safe work practices.