HIM Audit and Educ Specialist​/HIM Clinical Document Mgmt

HIM Audit and Educ Specialist / HIM Clinical Document Management

Join Hartford Health Care as a HIM Audit and Educ Specialist / HIM Clinical Document Management specialist. The role is based at 9 Farm Springs Rd, Farmington (10566).

We are looking for an experienced professional to develop and implement an effective audit and education program for coding, ensuring compliance with regulatory, contractual, professional standards and industry practices.

The Auditor & Education Specialist develops and implements an effective and comprehensive audit & education program for coding consistent with regulatory, contractual, professional standards and healthcare revenue cycle industry practices. The audit and education specialist will support documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD‑10 coding guidelines. The role reports to the Manager of Audit and Education.

• Performs revenue opportunity assessment and executes the professional audit work plan, which includes provider audit and education with QA. Compiles and prepares complex reports for distribution to key leadership stakeholders.
• Analyzes audit results, creates material for education and performs education and training for providers and staff to ensure updates and quality assurance on coding.
• Creates and trains on documentation templates designed for specialty/client (e.g., medical reports, monitoring/analysis reports, continuous auditing tools) to insure appropriate documentation is captured for services rendered.
• Researches literature from regulatory groups such as HHS/OIG, Medicare, Medicaid, NGS, and peer organizations to keep the organization current with regulatory requirements and accepted audit and education practices.
• Identifies common documentation and coding issues and process improvement and effectively communicates via memos and other documentation to disseminate audit requirements.
• Identifies process improvements to capture data for Medicare Risk Adjustment and helps providers code to the level of specification.
• Builds relationships, programs, and processes alongside providers that result in more accurate documentation and coding of diagnoses.
• Develops strategies to support knowledge transfer and testing to determine outcome and success of training.
• Provides individualized education to physicians and tracks performance over time.
• Demonstrates a face‑to‑face communication style and addresses issues as they arise.

This job reports to the Auditor and Education Specialist Manager.

• Education & Licenses
• Medical Coding License required (CPC, CCS-P, CCS).
• Minimum of five years’ experience with CPT, HCPCS and ICD‑10 coding conventions; experience with Medicare, Medicaid and third‑party billing and compliance regulations necessary.
• Experience with claim submission requirements.
• Demonstrated experience analyzing data, reviewing results and providing education to clinical providers and coders.
• Exemplary communication skills; ability to navigate challenging conversations and provide effective provider training in both large and small groups.
• Ability to influence providers to improve documentation.
• Experience in project management and follow‑up required.
• Progressive leadership responsibility.

• Preferred Qualifications
• Experience working with CMS, health insurers and medical providers.
• Minimum of seven years’ experience with CPT, HCPCS and ICD‑10.
• CPMA preferred.
• Baccalaureate degree preferred.
• CRC preferred (to be obtained within 6 months of hire).
• Experience with diagnosis coding and risk adjustment programs preferred.
• Experience in an educational/training role preferred.
• Experience with Word, Excel and PowerPoint required. Knowledge of Epic preferred.

• Medical Coding License (CPC, CCS-P, CCS)
• CRC preferred (required within 6 months of hire)

• Commitment to maintain confidentiality of patient health information.
• Will require on‑site auditing and training.
• Reliable transportation, insurance, and a valid driver’s license.
• Ability to excel in a fast‑paced business environment handling multiple priorities.
• Strong written and oral communication skills.
• Ability to exercise appropriate judgment when making decisions.

Hartford Health Care offers opportunities for career development and growth. Competitive benefits and work/life balance are part of our commitment to employees.