Provider Coding Education Specialist

Provider Coding Education Specialist

The Provider Education and Audit Specialist plays a crucial role in ensuring accurate and compliant coding practices within the healthcare organization. This position is responsible for educating healthcare providers on coding guidelines and best practices, as well as conducting regular audits to assess coding accuracy and compliance with regulatory requirements. Reporting to The Clinical Revenue Cycle Manager, the Provider Education and Audit Specialist is instrumental in optimizing revenue capture, minimizing compliance risk, and enhancing provider performance through targeted education and data-driven insights.

Conducts Provider Audits

• Plans and executes annual audits of coding practices across departments.
• Reviews provider documentation and coding for accuracy, completeness, and compliance with CMS, CPT, ICD-10, and payer-specific guidelines.
• Identifies areas of improvement and provides feedback to providers and relevant stakeholders based on audit findings.
• Maintains comprehensive records of audit results, compliance issues, and corrective actions taken
• Prepares reports and presentations summarizing audit findings, trends, and recommendations for improvement using current audit software.

Develops and Delivers Provider Education

• Develops and delivers educational programs and materials to healthcare providers on coding principles, guidelines, and updates.
• Conducts training sessions and workshops to enhance providers' understanding and application of coding standards.
• Educates providers on audit findings and regulatory updates.
• Creates educational materials, tip sheets, and job aids tailored to provider specialties.
• Provides one-on-one coaching to providers as needed.

Supports Regulatory Compliance

• Stays updated on changes in coding regulations and industry standards to ensure educational materials and audit processes remain current and effective.
• Ensures provider practices align with OIG, CMS, and payer compliance standards.
• Participates in internal and external audits and supports corrective action plans.
• Maintains documentation of education and audit activities for compliance tracking.

Collaborates with Revenue Cycle and Clinical Teams

• Collaborates with revenue cycle management to ensure coding practices align with organizational policies and regulatory standards.
• Fosters collaborative relationships with clinical staff, billing specialists, and administrative personnel to promote accurate and compliant coding practices.
• Participates in interdisciplinary meetings to address documentation and billing issues.
• Provides feedback to leadership on systemic issues impacting compliance or reimbursement.

Serves as a Coding Resource and Analyzes Trends

• Serves as a resource and point of contact for coding-related inquiries and issues from providers and internal stakeholders.
• Utilizes audit software and reporting tools to track provider performance.
• Identifies opportunities for improvement based on audit outcomes and KPIs.
• Prepares reports for leadership review.
• Recommends process improvements based on data analysis.

Required Qualifications

• Bachelor's degree in Healthcare Administration or a related field
• Certification in at least ONE of the following: Certified Coding Specialist (CCS) from AHIMA or Certified Professional Coder Instructor (CPC-I), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Physician Practice Manager (CPPM), Certified Documentation Expert Outpatient (CDEO), or Certified Professional Compliance Officer (CPCO) from AAPC
• 3 years of relevant experience in medical coding, auditing, or coding education within a healthcare setting.
• Strong knowledge of ICD-10, CPT, HCPCS, and other coding systems and guidelines.

Preferred Qualifications

• Master's degree in Health Informatics, Public Health or a related field.
• 5 years of relevant experience in medical coding, auditing, or coding education within a healthcare seeing, preferably in a large multi-specialty academic practice or an Ambulatory Surgical Center (ASC).
• Experience with MD Audit.
• Experience with EPIC.

Salary Range

$71,500 + depending on qualifications

Working Conditions

• Standard office equipment
• Repetitive use of a keyboard
• May be exposed to such occupational hazards as communicable diseases, blood borne pathogens, ionizing and non-ionizing radiation, hazardous medications and disoriented or combative patients, or others.

Required Materials

• Resume/CV
• 3 work references with their contact information; at least one reference should be from a supervisor
• Letter of interest