Purpose
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 organizational strategic objectives. Serves as a peer influencer and may direct a project or project team by applying industry experience and specialized knowledge.
Essential functions
- Researches, collects, and analyzes information to identify opportunities, develop solutions, and lead resolution efforts.
- Collaborates on performance improvement activities to support program efficiency and patient experience.
- Responsible for distribution of analytical reports.
- Uses multiple system applications to perform analysis, create reports, and develop educational materials.
- Researches and compiles information to support ad-hoc operational projects and initiatives.
- Synthesizes and analyzes data and provides detailed summaries, including graphical presentations and recommendations.
- Leverages program and operational data to define and demonstrate progress, ROI, and business impact.
- Maintains compliance with federal, state, and local laws and regulations, as well as Trinity Health policies and standards.
Functional role
- Provides high-level technical competency and subject matter expertise in coding and documentation review for complex services, including surgical procedures and 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 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 knowledge gaps.
- Provides training and onboarding for new audit and education colleagues and providers.
- Maintains coding quality and productivity standards established by Revenue Excellence.
Requirements & Qualifications
Minimum qualifications
- Associate degree in Health Information Management or a related field, or equivalent combination of education and experience.
- Extensive knowledge of ICD-10, HCPCS, CPT, and HCC guidelines.
- Knowledge of medical terminology, regulatory guidelines including Medicare and Medicaid, and payer policies.
- Five or more years of professional coding experience, including surgical procedures.
- Two years of auditing and/or education experience.
- One of the following credentials is required: RHIT, RHIA, CCS, or CPC.
Preferred qualifications
- Bachelor's degree in Health Information Management or a related healthcare field.
- Prior experience in auditing and provider education.
- Preferred credentials: CPMA, CRC, or CDEO.
Location
Michigan, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
2 weeks ago