Prof Bill Audit Edu Team Lead / HIM Clinical Document Mgmt

Work where every moment matters. 

Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. 

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

The Professional Billing Audit & Education Team Lead is responsible for supporting the daily operations and strategic direction of the audit and education team. This role also supports development and implementation of a comprehensive audit and education program that aligns with regulatory, contractual, and professional standards, as well as healthcare revenue cycle industry practices. The Team Lead provides guidance, mentorship, and quality oversight to Audit & Education Specialists, while also performing audits, delivering education, and supporting documentation practices that comply with CMS guidelines, risk adjustment requirements, and ICD-10 coding standards.

Position Responsibilities:

Key Areas of Responsibility

Audit and Education

1.   Performs revenue opportunity assessment and executes the professional audit work plan which includes provider audit and education.

2.   Compiles and prepares complex reporting from internal, vendor and AI sources for distribution to key stakeholders.

3.   Analyzes audit results, creates training material and performs education and training for providers and staff. Tracks performance patterns and results. Disseminates results to key stakeholders.

4.   Researches guidance 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.   Creates education to support Medicare Risk Adjustment initiatives.

6.   Partners with providers to influence accurate and compliant documentation practices.

7.   Reviews and provides feedback on education materials.

8.   Works to identify and resolve team and customer issues.

Communication

1.   Collaborate with other departments (Coding, Revenue Integrity, etc.) to achieve expected outcomes.

2.   Seeks clarification from providers where documentation is absent, ambiguous, or contradictory and makes appropriate corrections.

Team Support

1.   Provides day-to-day operational support to the Audit and Education team, ensuring alignment with organizational goals and regulatory standards

2.   Onboards new Audit and Education team colleagues. Provides ongoing feedback, assists with coaching, mentoring, recruiting, developing and retaining Audit and Education Specialists. Provides continuing education for the Audit and Education Specialist and tracks requirements for job role and credentialing.

3.   Completes additional assignments and special projects as requested.

Working Relationships:

This Job Reports To (Job Title): Audit and Education Manager

Education

·        Minimum: Associate’s Degree or equivalent experience

·        Preferred: Baccalaureate degree not required but preferred

Experience

        ·            Minimum:

o   Eight years experience with

o   CPT, HCPCS and ICD-10 coding conventions required. 

o   Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations

o   Experience with Claim Submission requirements

o   Experience analyzing data, reviewing results and creating appropriate mitigating action plans.

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   Experience in project management.

o   Progressively responsible leadership responsibilities 

        ·            Preferred:

o   Minimum of ten years experience

o   Experience working in an educational/ training role preferred.

Licensure, Certification, Registration

        ·            Minimum:

o   Medical Coding License required (CPC, or CCS-P, or CCS).

o   And CPMA

o   And CRC

Preferred:

o   CCDS Certified Clinical Documentation Specialist or

o   CPCO Certified Professional Compliance Officer or

o   CDIP Certified Documentation Integrity Professional

Knowledge, Skills and Ability Requirements:

Extensive Knowledge of:

·        ICD‑10-CM diagnostic and CPT/HCPCS procedure codes

·        Clinical information related to areas of responsibility

Skills:

·        Read, write and speak English proficiently.

·        Strong analytical and critical thinking capabilities.

·        Excellent organizational skills.

·        Proficiently read and interpret physician documentation.

·        Experience with Word, Excel and PowerPoint 

·        Knowledge of business systems, e.g., Epic

Strong ability to:

·        Function independently.

·        Handle multiple priorities.

·        Deliver results individually and through a team.

·        Delegate tasks effectively to others.

·        Create a positive learning environment.

·        Practice active listening.

·        Communicate clearly using appropriate verbal and body language.

·        Collaborate with others to achieve a common goal through mutual cooperation.

·        Influence others for positive and productive outcomes.

·        Work across the Hartford HealthCare System.

·        Work on site as needed.

·        Thrive in a fast-paced business environment handling multiple priorities. 

·        Demonstrate H3W Leadership Behaviors.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.