ASC​/Professional Surgical Coding Auditor & Educator (REMOTE

Job Title

Employment Type:

Full time

Purpose:

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization's strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

Note:

"patients" refers to patients, clients, residents, participants, customers, members

Our Trinity Health Culture:
Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus:
Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.

Process Focus:
Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis:
Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Maintains a working knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

• Provides high level technical competency & subject matter expertise analyzing coding and documentation review for complex services, including code selection of surgical procedures & assessment of high-acuity type services.

• Conducts comprehensive audits of professional coders and providers to ensure accuracy, compliance, and alignment with CPT, ICD 10, HCPCS, HCC and payer specific-specific guidelines.

• Analyze documentation and coding patterns to identify risks related to compliance, revenue integrity, and regulatory requirements.

• Provides clear, actionable feedback to providers, coders, and leadership to improve documentation quality and coding accuracy.

• Develops and delivers targeted education and training programs based on audit findings, regulatory updates, and identified knowledge gaps.

• Provides training and onboarding to new audit and education of colleagues & providers.

• Adheres to coding quality & productivity standards as established by Revenue Excellence;
  Maintains accuracy of 95% or greater per coding audits;
  Responsible for completion of audit and education workplan as defined by the Service Area Manager of Coding Audit and Education.

• Associate degree in Health Information Management or a related field or an equivalent combination of years of education & experience. Must possess extensive knowledge of ICD-10, HCPCS, CPT, and HCC guidelines, medical terminology, regulatory guidelines including Medicare and Medicaid, and payer polices.

• Five (5) or more years of professional coding experience including surgical procedures and two (2) years of auditing and or education.

• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Coding Profession Certification (CPC) is required.

• Bachelor's degree in health information management (HIM) or related healthcare field is preferred

• Preferred prior experience in auditing and provider education.

• Preferred credentials:
  Certified Professional Medical Auditor (CPMA), Certified Risk Coder (CRC), Clinical Documentation Expert – Outpatient (CDEO).

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional

• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional

• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional

• Exposure to interruptions, shifting priorities & stressful situations. Frequent

• Ability to follow tasks through to…