Position Summary:
The Audit & Education Specialist develops and implements an effective and comprehensive audit & education program for coding consistent with regulatory, contractual, professional standards and healthcare revenue cycle industry practices. The audit and education specialist will support documentation practices that comply with CMS on evaluation and management, procedure, risk adjustment program requirements and ICD 10 coding guidelines. Reporting to Manager of Audit and Education
Position Responsibilities:
Key Areas of Responsibility
1. Performs revenue opportunity assessment and executes the professional audit work plan which includes provider audit and education with QA. Compile and prepares complex reports for distribution to key leadership stakeholders.
2. Analyzes audit results, creates material for education and performs education and training for providers and staff to ensure updates and quality assurance on coding.
3. Creates and trains on documentation templates designed for specialty/client, e.g., medical reports, monitoring/analysis reports, continuous auditing tools, etc. to insure appropriate documentation is captured for services rendered.
4. Researches literature from regulatory groups such as; HHS/OIG, Medicare, Medicaid, NGS, etc., professional and peer organizations' practices/policies/guidelines to keep organization current with regulatory requirements and accepted audit and education practices.
5. Identify common documentation and coding issues and process improvement and effectively communicates via memos and other documentation to disseminate audit requirements.
6. Identify process improvements to capture data for Medicare Risk Adjustment and help providers code to the level of specification
7. Builds relationships, programs, and processes alongside providers that will result in more accurate documentation and coding of diagnoses
8. Develops strategies to support knowledge transfer and testing to determine outcome and success of training
9. Provides individualized education to physicians and tracks performance over time
10. Demonstrate a face to face communication style and address issues as they arise
Working Relationships:
This Job Reports To: Audit and Education Specialist Manager

Qualifications:

Education
 Minimum:
o Medical Coding License required (CPC, CCS-P, CCS).
o Minimum of five years' work experience with CPT, HCPCS and ICD-10 coding conventions required. Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary. Experience with Claim Submission requirements required
o Demonstrates experience analyzing data, review results and providing education to both clinical providers and coders in a productive manor.
o Exemplary communication skills; ability to navigate challenging conversations and provide effective provider training in large and small groups.
o Effectively able to influence providers to improve documentation
o Demonstrates experience in project management and follow up required
o Progressively responsible role with leadership
 Preferred:
o Experience working with CMS, health insurers and medical providers strongly desired.
o Minimum of seven years' work experience with CPT, HCPCS, and ICD-10
o CPMA not required but preferred
o Baccalaureate degree not required but preferred
o CRC not required but preferred (it is expected that candidates that are not CRC qualified will obtain the qualification within the first 4 - 6 months of their employment with Hartford Healthcare
o Experience with the nuances of diagnosis coding and risk adjustment programs preferred
o Experience working in an educational/ training role preferred.
o Experience with Word, Excel and PowerPoint required. Knowledge of business systems, e.g., Epic preferred
Licensure, Certification, Registration
 Medical Coding License (CPC, CCS-P, CCS)
 CRC preferred (required within 6 months of hire)
Knowledge, Skills and Ability Requirements:
 Commitment to maintain complete confidentiality of patient health information
 Will require on site auditing and training
 Reliable transportation, insurance, and a valid driver's license
 Must be able to excel in a fast paced business environment handling multiple priorities. Must be highly effective in both written and oral communication
 Must be able to exercise appropriate judgment when making decisions.