Position Summary:
The Risk Adjustment Coder Educator develops and implements an enterprise-wide risk adjustment coding and documentation education program to support documentation practices among contracted providers that comply with CMS risk adjustment program requirements and ICD 10 coding guidelines. The Risk Adjustment Coder Educator will serve as a training resource for Risk Adjustment department staff and associated departments.
Position Responsibilities:
Key Areas of Responsibility
1. Oversees the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and documentation training programs including defining training objectives, developing training materials and tools
2. Implements documentation and coding training programs for Medicare Advantage contracted providers. Presents coding and documentation education in a variety of settings
3. Identify process improvements to capture data for Medicare Risk Adjustment
4. Builds relationships, programs, and processes alongside providers that will result in more accurate documentation and coding of diagnoses
5. Develops strategies to support knowledge transfer and testing to determine outcome and success of training
6. Provides individualized education to physicians and tracks performance over time
7. Creates train the trainer guides and participant materials
8. Demonstrate a face to face communication style and address issues as they arise
9. Support the team's success by providing necessary resources and breaking down barriers
10. Provide necessary resources and helps to remove obstacles while demonstrating personal commitment to the group
Working Relationships:
This Job Reports To (Job Title): Manager Risk Adjustment Coding
Qualifications:
Requirements and Specifications:
Education
• Minimum: Bachelors degree or equivalent work experience
• Preferred: Bachelors or Associate's degree
Experience
• Minimum: of 3-5 years in medical claims coding required
• Preferred:
o Experience working with CMS, health insurers and medical providers strongly desired.
o Experience with the nuances of diagnosis coding and risk adjustment programs preferred
o Progressively responsible role with leadership experience and previous experience working in an educational/training role preferred.
Licensure, Certification, Registration
• Minimum: Medical Coding Certification, Certified Professional Coder (CPC), Certified Coding Specialist - Physician (CCS-P) or Certified Coding Specialist (CCS)
• Preferred: Certified Risk Adjustment Coder (CRC) preferred (required within 6 months of hire)
Knowledge, Skills and Ability Requirements:
• Commitment to maintain complete confidentiality of patient health information
• Will require on site auditing and training
• Reliable transportation, insurance, and a valid driver's license
• Must be able to excel in a fast paced business environment handling multiple priorities. Must be highly effective in both written and oral communication
• Must be able to exercise appropriate judgment when making decisions
