Professional Services Auditor and Educator

Trinity Health; Orlando (FL); Remote; USD 60,000 - 90,000; Full time

Job summary

A leading healthcare provider in Florida is seeking a Medical Auditor to conduct comprehensive audits and provide practitioner education on coding and documentation. This role requires a deep understanding of healthcare coding regulations and experience with auditing processes. The successful candidate will ensure compliance and optimize revenue capture while partnering with various teams to enhance overall accuracy and efficiency.

Qualifications

• 3-5 years of professional coding or auditing experience required.
• Must possess CPC, CRC, RHIT, CDEO, or equivalent certification.
• Expert knowledge in ICD-10 and CPT coding and medical terminology.

Responsibilities

• Perform annual and targeted audits of medical records and coding.
• Educate providers on documentation guidelines.
• Coordinate compliance benchmarks and standards across regions.

Skills

Medical coding

Data analysis

Healthcare compliance

Education

Associate degree in Health Information Management

Bachelor’s degree in Health Information Management or related field

Job description

Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

Performs annual and targeted medical record audits including, but not limited to analysis of medical record documentation; validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes by providers. Monitors accuracy of centralized coders charge capture and coding. Partners with centralized coding and operational leadership to improve HCC, high risk scoring, along with provider and coder education. Responsible for practitioner education in areas related to coding, documentation, and compliance.

ESSENTIAL FUNCTIONS

Responsibilities, including but not limited to:

Educate providers on documentation guidelines, in annual sessions and individually as required.

Determine if organizational policies are current and effective.

Ensure appropriate revenue is captured; and Defend against federal and payer audits, malpractice litigation, and health plan denials

Compare evaluation and management code utilization by provider, with comparison to national benchmarking, to identify potential outliers and audit risks. Performs provider targeted and focused prospective and retrospective audits of documentation compared to services billed for new and established providers.

Coordinates and partners with local ministry and System Office Integrity and Compliance benchmarks and standards.

Plans, prepares, and regularly conducts audits/reviews and other compliance related projects within an area of expertise relative to a specific healthcare service line.

Acts as a technical resource for documentation, coding and billing regulations for assigned medical groups and regions.

Prepares and performs audit related educational sessions and presents those sessions in collaboration with medical group providers, division leadership, and within group settings or one-on-one.

Trains and assists in the education, audit, and development of the Centralized Coding team.

MINIMUM QUALIFICATIONS

Associate degree in Health Information Management or a related field or an equivalent combination of years of education and experience. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred. Must possess a comprehensive knowledge of professional coding, regulatory guidelines, and payer policies with three (3) to five (5) years of professional coding or auditing experience.

Required: CPC, CRC, RHIT, CDEO, or equivalent certification

Preferred: CPMA or CCDS-O in conjunction with CPC, RHIT, CRC or CDEO accreditation

Preferred: Extensive knowledge of medical data auditing, interpretation, and analysis.

Preferred: Four (4) to six (6) years of professional coding experience; ability to code from operative reports, progress, and other note types.

Must have an in-depth knowledge of Medicare and Medicaid documentation, coding, and billing regulations for applicable service lines(s) assigned, in addition to CMS Conditions of Participation. Additional knowledge of other third-party payer requirements for documentation, coding and billing preferred.

Ability to review clinical documentation to determine accurate ICD10, CPT, HCPCS and modifier assignment.

Ability to work remotely from home following Trinity remote work guidelines.

Expert knowledge in ICD-10 and CPT coding and medical terminology, with knowledge of Medicare, Medicaid, Health Maintenance Organization, and commercial insurance plans.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.