Professional Coding Auditor & Educator
Company: Trinity Health
Location: Silver Spring
Posted on: November 12, 2021
The Professional Coding Auditor Educator performs medical record
audits including but not limited to analysis of medical record
documentation, validation of primary and secondary diagnoses and
procedures; and ensuring proper assignment of diagnosis and
procedure codes using coding guidelines established by the Centers
for Medicare and Medicaid Services (CMS). Monitors accuracy of
centralized coders' charge capture and coding with proper ICD-10,
CPTs, as well as proper modifiers, adhering to local ministry and
Trinity practices and policies. Partners with leadership to improve
HCC, high risk scoring, with provider and coder education. Conducts
ongoing reviews of patient medical record documentation and
procedural and diagnosis coding by each practitioner. Responsible
for practitioner education in areas related to coding,
documentation and compliance. Works closely with leadership and the
department to establish and modify the charge description master
(CDM) methodology and pricing models to ensure accuracy and
Supports the Mission of Holy Cross Health and Trinity Health.
Minimum licensure/certification required (if applicable):
Minimum Knowledge, Skills, & Abilities Required:
- High school diploma or equivalent combination of education and
- Certified Professional Coder or Registered Health Information
- Minimum of 2-5 years of professional coding experience with
comprehensive knowledge of ICD-10, CPT, and HCPCs modifiers.
Knowledge of Medicare, Medicaid, and other third-party billing
rules and regulations.
- Preferred 3-6 years of professional coding experience; ability
to code from operative reports; prior auditing experience.
- Effective verbal, written, and interpersonal communication
skills with the ability to comfortably interact with diverse
- Ability to work collaboratively in a team-oriented environment
with a strong customer-service orientation.
- Ability to handle patient and organizational information in a
- Demonstrated dependability and regular attendance.
- Ability to demonstrate competency with a standard desktop and
Windows-based computer system, including a basic understanding of
email, e-learning, intranet and computer navigation. Ability to use
other software as required to perform the essential functions of
- Solid understanding of ICD-10 and CPT coding and medical
terminology, with knowledge of Medicare, Medicaid, Health
Maintenance Organization and commercial insurance plans.
- Ability to maintain accurate records and to prioritize and
organize work effectively.
- Ability to exercise independent judgment as appropriate within
standard practices and procedures.
Physical Requirements: Sedentary work. Exerting up to 10 pounds of
force occasionally and/or negligible amount of force frequently or
constantly to lift, carry, push, pull or otherwise move objects,
including the human body. Sedentary work involves sitting most of
the time. Jobs are sedentary if walking and standing are required
only occasionally and all other sedentary criteria are met.
Visual Acuity: The worker is required to have close visual acuity
to perform an activity such as: preparing and analyzing data and
figures; transcribing; viewing a computer terminal; extensive
reading; visual inspection involving small defects, small parts,
and/or operation of machines (including inspection); using
measurement devices; and/or assembly or fabrication parts at
distances close to the eyes.
Environmental Conditions: None. The worker is not substantially
exposed to adverse environmental conditions (such as in typical
office or administrative work.) Incumbent communicates frequently,
in person and over the phone, with people in all locations on
product support issues. The environment in which the incumbent will
work requires the ability to concentrate, meet deadlines, work on
several projects at the same time and adapt to interruptions.
Must be able to set and organize own work priorities and adapt to
them as they change frequently. Must be able to work concurrently
on a variety of tasks/projects in an environment that may be
stressful with individuals having diverse personalities and work
Ability to thrive in a fast-paced, multi-customer environment, with
conflicting needs which some may find stressful. May warrant varied
and/or extended hours, with changes in workload and priorities to
keep pace with the industry and advance strategic priorities.
May be required to travel up to 25% between locations within the
The above statements are intended to describe the general nature
and level of work being performed by persons assigned to this
classification. They are not to be construed as an exhaustive list
of duties so assigned.
Reports to the Manager, Provider Revenue Operations.
Holy Cross Health is an Equal Employment Opportunity (EEO)
Qualified applicants are considered for employment without regard
to Minority/Female/Disabled/Veteran (M/F/D/V) status.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of
hospitals and hundreds of health centers in 22 states. Because we
serve diverse populations, our colleagues are trained to recognize
the cultural beliefs, values, traditions, language preferences, and
health practices of the communities that we serve and to apply that
knowledge to produce positive health outcomes. We also recognize
that each of us has a different way of thinking and perceiving our
world and that these differences often lead to innovative
Trinity Health's dedication to diversity includes a unified
workforce (through training and education, recruitment, retention
and development), commitment and accountability, communication,
community partnerships, and supplier diversity.
Keywords: Trinity Health, Silver Spring , Professional Coding Auditor & Educator, Accounting, Auditing , Silver Spring, Maryland
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