Risk Adjustment Educator
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Job Description
Risk Adjustment Educator educating and advising providers on Medicare coding guidelines. Collaborating with health plans to enhance revenue and improve coding accuracy.
Responsibilities:
- Responsible for educating and advising providers and practice staff in Medicare coding guidelines, focusing on revenue enhancement opportunities.
- Work in collaboration with other PHP departments and Optum/United HealthCare Medicare Advantage(MA) or other health plans to develop plans and materials that support education and system changes to meet practice and IPA revenue goals.
- Collaborates to develop plans and present to practices the HCC education program that reflects IPA ethical standards and Medicare guidelines.
- Collaborate with Optum and PHP data analysts to develop meaningful practice-level reporting to assist in coding and code submission more effectively.
- Work with contracted Medicare Advantage plans, Optum and other third party vendors to drive or supplement educational forums and reports.
- Identify potential data flow obstacles within assigned practices and work with practice staff to develop action plans to assist practices in overcoming obstacles.
- Identify and solve issues with other vendors (billing companies, clearinghouse, etc.) to remove obstacles that prevent maximum code extraction and submission.
- Risk adjustment chart reviews.
- Educate physicians and office staff on coding techniques to accurately document and capture patient acuity to the highest degree of specificity while maintaining Medicare guidelines.
- Maintains working knowledge of changing health industry environment related to the risk adjustment model and CMS expectations such as tolerance, fraud/abuse responses, etc.
- Remain current on CEUs to maintain CPC and other professional certifications.
- Be a primary resource for physicians and office staff to answer questions or access resources to support documentation and coding for risk adjustment.
- Interface with assigned practices on a regular basis to help develop and maintain engagement levels of practices.
- Build relationships with practices to help them understand the importance of documentation and coding in a manner that addresses overall patient care management and IPA revenue goals.
Requirements:
- Bachelors’ degree in health related field required.
- Four years of related work experience may be considered in lieu of a degree.
- Certified Professional Coder (CPC) required.
- Certified Risk Adjustment Coder (CRC) required or commitment to get within 1 year of employment.
- Three to five years’ experience with medical records and/or medical coding, preferably risk adjustment coding.
- Knowledge of health care insurance claims practice and compliance.
- Knowledge of Medicare rules and guidelines.
- Knowledge of Claims Coding (CPT, HCPCs, ICD-10, HCFA 1500).
- Knowledge of risk adjustment categories and hierarchy preferred.
- Knowledge of MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, other software programs and internet based applications as needed to fulfill position duties.
- Skilled in synthesizing data and questions to communicate a cohesive educational training program.
- Skilled in responding to practice inquiries in a timely and accurate manner.
- Skilled in working collaboratively with various parties to communicate an accurate and meaningful reporting package for practices.
- Able to work effectively with physicians, practice staff, health plan/other external parties and PHP multidisciplinary team to streamline efforts to meet HCC Coding goals.
- Able to work with sensitive data and relay potential issues or concerns in a diplomatic manner.
- Able to multi-task and meet deadlines.
- Able to work with external parties to obtain resources as needed.
- Able to communicate findings in a clear, concise manner, both internally and externally, including presentations.
Benefits:
- Reliable and insured vehicle
- Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures
- Mobile Device for work purposes as defined by the company policies and procedures
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