Risk Adjustment Education Specialist-Health Plan Admin in Irving, TX

Summary:

This Job will report to the Risk Adjustment Manager of Coding Operations. Responsibilities will include provider medical record audits, analysis of practice coding patterns, education, and training regarding risk adjustment. You will also analyze data to identify patterns and development of interventions at the provider level.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Subject matter experts for proper risk adjustment coding and CMS data validation.
• Work in conjunction with other departments, including Provider Relations, Quality, and the Medical Director, to ensure compliance with CMS risk adjustment guidelines.
• Analyze MRA data to identify patterns and development of provider and market-level interventions to coordinate an educational work plan for providers.
• Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and improve care quality.
• This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Responsible for building positive relationships with assigned Physicians and serving as a contact for any questions or concerns that may arise.
• Identify those Practices that need initial or ongoing additional training.
• Must be proficient in Prospective, Retrospective, and Concurrent review processes.
• This Job does require the ability to have reliable transportation to conduct ongoing face-to-face interactions with Providers.
• Must have strong clinical knowledge of disease pathology and ability to identify clinical indicators related to chronic disease.
• Must be self-motivated: energetic, self-starter; can work autonomously with limited direction.
• Must be results-oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes.
• Must be analytical: vital research, writing, analytical, and critical reasoning skills.
• Must be a good communicator: conveys thoughts and expresses ideas concisely and effectively both verbally and in writing; strong presentation skills.
• Must be a good collaborator: orientation to team-based work product and results, open to change and process enhancement.
• Perform other duties as necessary.

Job Requirements:

Education/Skills

• Associate degree or equivalent experience required.

Experience

• 5 years of experience in a hospital, a physician setting, or a Managed Care Organization as a medical coder required.
• 2 years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) required.
• Other experience in teaching, training, or an educator/instructor role is needed, but provider education experience is preferred.

• Must have experience in creating effective training materials and presentations (PowerPoint, Adobe, etc.)

Licenses, Registrations, or Certifications

• Certified Professional Coder (CPC) from AAPC is required.
• Certified Risk Adjustment Coder (CRC) from AAPC is preferred.
• An RN or LVN must obtain both CPC and CRC within 12 months of hire.

Work Type:

Full Time