ASC/Professional Surgical Coding Auditor & Educator (REMOTE)

Full-time position.

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.

Note: “patients” refers to patients, clients, residents, participants, customers, and members.

Responsibilities

• Researches, collects, and analyzes information. Identifies opportunities, develops solutions, and leads 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.
• Incorporates basic knowledge of Trinity Health policies, practices, and processes to ensure quality, confidentiality, and safety.
• Demonstrates knowledge of departmental processes and procedures and ability to readily acquire new knowledge.
• Researches and compiles information to support ad-hoc operational projects and initiatives.
• Synthesizes and analyzes data, providing detailed summaries including graphical data presentations illustrating trends and recommending practical options or solutions.
• Leverages program and operational data and measurements to define and demonstrate progress, ROI, and impacts.
• Maintains a working knowledge of applicable federal, state, and local laws/regulations, Trinity Health Integrity and Compliance Program, and Code of Conduct.
• 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 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 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 of 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.

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.

Qualifications

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

Physical & Mental Requirements

• Exposure to conditions which may be considered unpleasant to sight, touch, sound, and/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, and conditions.
• Occasional exposure to interruptions, shifting priorities, and stressful situations.
• Frequent ability to follow tasks through to completion, understand and relate to complex ideas/concepts, remember multiple tasks and regimens over long periods of time, and work on concurrent tasks/projects.
• Continuous ability to read small print, hear sounds and voice/speech patterns, give/receive instructions and other verbal communications (in-person and/or over the phone/computer/device/equipment assigned) with some background noise.
• Frequent performance of manual dexterity activities and/or grasping/handling.
• Occasional ability to climb, kneel, crouch, and/or operate foot controls.
• Frequent use of a computer/other technology.
• Frequent sitting with the ability to vary/adjust physical position or activity.
• Continuous maintenance of a safe working environment and use of available personal protective equipment (PPE).
• Continuous compliance with Trinity Health’s Code of Conduct, policies, procedures, and guidelines.
• Occasional ability to provide assistance in the event of an emergency.
• Perform activities that require standing/walking with the ability to vary/adjust physical position or activity.
• Occasional lifting of a maximum of 30 pounds unassisted.
• Occasional experience of long periods of walking/standing/stooping/bending/pulling/pushing.
• Occasional encounter with a clinical/patient-facing/hands-on interactive work environment.
• Work indoors (subject to travel requirements) under temperature-controlled and well-lit conditions.