Professional Coding Auditor & Educator (REMOTE)

Trinity Health•Livonia, MI

5d•Remote

About The Position

The Professional Coding Auditor & Educator uses specialized knowledge, data analysis, critical thinking, and problem-solving skills to support organizational objectives and influence colleagues and leadership. The role researches and analyzes information, identifies opportunities, develops solutions, collaborates on performance improvement, and distributes analytical reports. It uses multiple system applications to perform analyses, create reports, and develop educational materials, while applying organizational policies and processes to prioritize quality, confidentiality, and safety. The role provides technical expertise in coding and documentation review for complex services, including surgical procedures and 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 coding and documentation patterns for compliance, revenue integrity, and regulatory risks, and provides actionable feedback to improve documentation quality and coding accuracy. The role also develops and delivers education based on audit findings, regulatory updates, and knowledge gaps, and supports onboarding and training for colleagues and providers. The position is accountable for meeting Revenue Excellence coding quality and productivity standards, maintaining at least 95% accuracy in coding audits, and completing the audit and education workplan defined by the Service Area Manager of Coding Audit and Education. It requires adherence to applicable laws, regulations, organizational policies, the Integrity & Compliance Program, and the Code of Conduct.

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; regulatory guidelines including Medicare and Medicaid; 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 certifications is required: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Professional Certification (CPC).
Ability to research and analyze data, think critically, solve problems, and communicate findings and recommendations.
Ability to follow tasks through to completion, understand complex concepts, manage multiple tasks and projects, and adapt to shifting priorities.
Ability to use a computer and other assigned technology, read small print, and communicate verbally and in writing, including by phone or computer.

Nice To Haves

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

Responsibilities

Research, collect, compile, and analyze information for operational projects, initiatives, and ad hoc requests.
Identify opportunities, develop solutions, and lead issues through resolution.
Collaborate on performance improvement activities related to program efficiency and patient experience.
Prepare and distribute analytical reports and detailed summaries, including graphical presentations of trends and practical recommendations.
Use multiple system applications to conduct analyses, create reports, and develop educational materials.
Assess program and operational data and measurements to demonstrate progress, return on investment, and impacts, supporting leadership decision-making.
Conduct comprehensive audits of professional coders and providers, including coding and documentation reviews for complex services, surgical procedures, and high-acuity services.
Evaluate code selection and compliance with CPT, ICD-10, HCPCS, HCC, payer-specific, and regulatory guidelines.
Analyze coding and documentation patterns to identify compliance, revenue integrity, and regulatory risks.
Provide clear, actionable feedback to providers, coders, and leadership to improve documentation quality and coding accuracy.
Develop and deliver targeted education and training based on audit findings, regulatory updates, and identified knowledge gaps.
Provide training and onboarding to new audit and education colleagues and providers.
Meet Revenue Excellence coding quality and productivity standards, maintain at least 95% accuracy per coding audits, and complete the audit and education workplan established by the Service Area Manager of Coding Audit and Education.
Maintain knowledge of applicable laws and regulations, organizational policies and procedures, the Integrity & Compliance Program, and the Code of Conduct, and follow safe work practices.