ASC/Professional Surgical Coding Auditor & Educator (REMOTE)

Employment Type: Full time

About the Role

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

Responsibilities

• Researches, collects, and analyzes information to identify opportunities, develop solutions, and lead through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency and patient experience.
• Responsible for distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports, and develop educational materials.
• Demonstrates knowledge of departmental processes and procedures and ability to acquire new knowledge.
• Synthesizes and analyzes data, providing detailed summaries including graphical presentations to illustrate trends and recommend practical solutions.
• Leverages program and operational data to define and demonstrate progress, ROI, and impacts.
• Provides high-level technical competency and subject matter expertise analyzing coding and documentation review for complex services, including code selection of surgical procedures and assessment of high-acuity services.
• Conducts comprehensive audits of professional coders and providers to ensure accuracy, compliance, and alignment with CPT, ICD-10, HCPCS, HCC, and payer-specific guidelines.
• Analyzes 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 colleagues and providers.
• Adheres to coding quality and productivity standards as established by Revenue Excellence; maintains accuracy of 95% or greater per coding audits.
• Responsible for completion of audit and education work plan as defined by the Service Area Manager of Coding Audit and Education.
• Maintains a working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity and Compliance Program, and Code of Conduct.

Requirements

• Associate degree in Health Information Management or a related field or an equivalent combination of years 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 (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 Professional Certification (CPC) is required.

Preferred Qualifications

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

Physical & Mental Requirements

• Occasional exposure to conditions which may be unpleasant to sight, touch, sound, and/or smell, including fumes, odors, dusts, mists, gases, biohazards, and hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects).
• Occasional exposure to noise, infectious waste, diseases, and conditions.
• Frequent ability to follow tasks through to completion, understand and relate to complex ideas/concepts, and work on concurrent tasks/projects.
• Continuous ability to read small print, hear sounds and voice/speech patterns, and give/receive instructions with some background noise.
• Frequent manual dexterity activities and/or grasping/handling.
• Occasional ability to climb, kneel, crouch, and/or operate foot controls.
• Frequent use of a computer or other technology.
• Frequent sitting with the ability to vary/adjust physical position or activity.
• Continuous maintenance of a safe working environment and use of personal protective equipment (PPE).
• Occasional ability to provide assistance in the event of an emergency.
• Occasional standing/walking with the ability to vary/adjust physical position or activity.
• Occasional lifting of a maximum of 30 pounds unassisted.
• Occasional long periods of walking/standing/stooping/bending/pulling/pushing.
• Occasional encounter with a clinical/patient-facing/hands-on interactive work environment.
• Continuous work indoors under temperature-controlled and well-lit conditions.