Trainee Risk Adjustment Auditor Jobs Near Me

Overview:
HYBRID Role (primarily 2 days in office/3 days WFH but may vary based on educational needs/initiatives). Working hours between 7am-6pm Mon-Fri.
In office for introductory/training/Onboarding period.
Job Description Summary:
Designs and delivers education programs on compliant documentation, coding and billing practices, regulatory requirements, and internal policies through learning experiences such as instructor-led sessions, webinars, and e-learning modules. Serves as a key resource for physicians, clinical staff, auditors, coders, and other stakeholders, ensuring understanding and adherence to applicable standards. Analyzes data and reports to identify educational needs and may conduct limited audits to support targeted training efforts.
Job Description:
Essential Functions:

• Develops and delivers targeted education based on new service or program implementation, CPT/ICD-10 changes, and regulatory changes. Reviews audit data and compliance trends to identify educational gaps and address areas of risk.
• Designs and maintains educational content and resources, supporting accurate CPT and diagnosis coding for professional services, and ensuring alignment with ICD-10-CM and clinical documentation standards.
• Leads the new provider onboarding process, including initiating education, assigning modules, tracking completion, and expanding educational content tailored to NCH specialties and service lines.
• Collaborates with HIM, CDI, Coding, and Compliance teams to align educational strategies with internal policies and regulatory requirements.
• Supports communication and clarification of coding compliance-related topics between coding/billing personnel and clinical teams to promote understanding and adherence.
• Provides virtual and onsite training to providers and staff, adapting content to meet the needs of various specialties and service lines.

Education Requirement:
Bachelor's Degree in Health Information Management, Nursing, Healthcare Administration, or a related field, required.
Licensure Requirement:
Licensure as a Registered Nurse (RN) or other clinical credential, preferred.
Certifications:

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-based (CCS-P), Registered Health Information Technician (RHIT), or other similar certification, required.
• Certified Risk Adjustment Coder (CRC) or Certified Documentation Integrity Practitioner (CDIP), preferred.

Skills:

• Proficiency with LMS platforms and virtual training tools.
• Proficiency with EPIC and MDaudit or similar systems.
• Proficiency with data visualization tools such as Qlik.
• Strong visual and graphic design skills.
• Demonstrated initiative, ownership, and a results-driven approach.
• Ability to work independently while fostering collaboration across multidisciplinary teams.

Experience:

• Four years of experience in professional and facility coding/auditing or clinical documentation, required.
• Experience in a pediatric healthcare setting, preferred.
• Two years of compliance experience in a healthcare setting, required.
• Experience developing education content, required.
• Teaching or public speaking experience, required.
• Clinical experience, preferred.

Physical Requirements:
OCCASIONALLY: Lifting / Carrying: 0-10 lbs, Standing, Walking
FREQUENTLY: (none specified)
CONTINUOUSLY: Audible speech, Computer skills, Decision Making, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"