Provider Coding Education Specialist

Job Details

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Purpose

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.

Responsibilities

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
• Certifications in one or more of the following:
• 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)
• Certified Professional Compliance Officer (CPCO)
• Certified Coding Specialist (CCS)
• 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.
• Equivalent combination of education and experience may be considered.

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 Athena.

Salary Range

$63,000 + 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

Important for applicants who are NOT current university employees or contingent workers: You will be prompted to submit your resume the first time you apply, then you will be provided an option to upload a new Resume for subsequent applications. Any additional Required Materials (letter of interest, references, etc.) will be uploaded in the Application Questions section; you will be able to multi-select additional files. Before submitting your online job application, ensure that ALL Required Materials have been uploaded. Once your job application has been submitted, you cannot make changes.

Important for Current university employees and contingent workers: As a current university employee or contingent worker, you MUST apply within Workday by searching for Find UT Jobs. If you are a current University employee, log-in to Workday, navigate to your Worker Profile, click the Career link in the left hand navigation menu and then update the sections in your Professional Profile before you apply. This information will be pulled in to your application. The application is one page and you will be prompted to upload your resume. In addition, you must respond to the application questions presented to upload any additional Required Materials (letter of interest, references, etc.) that were noted above.

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Employment Eligibility:

Regular staff who have been employed in their current position for the last six continuous months are eligible for openings being recruited for through University-Wide or Open Recruiting, to include both promotional opportunities and lateral transfers. Staff who are promotion/transfer eligible may apply for positions without supervisor approval.

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Retirement Plan Eligibility:

The retirement plan for this position is Teacher Retirement System of Texas (TRS), subject to the position being at least 20 hours per week and at least 135 days in length.

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Background Checks:

A criminal history background check will be required for finalist(s) under consideration for this position.

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