Medicare Sr. Coding & Quality Educator

Job Summary

The work of a Sr. Coding & Coding Quality Educator relates to practices and principles associated with medical record auditing and utilizes various techniques in examining, evaluating and providing feedback and training to various stakeholders (certified coders, physician's practices, etc.) Key responsibilities include setting up a standard medical record auditing process and assisting in all matters relating to implementation of coding quality and coding training programs for Coders and Physicians, creating an integrated Program plan to carry out goals and managing/monitoring progress of the program execution.

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Work closely with and coach certified coders and assist in assessing the strengths and weaknesses, ensuring that quality issues translate into timely training and ongoing coding reinforcement to the coders.
• Verify, document and communicate quality audit results, develop audit reports and evaluate the effectiveness of corrective action plans and follow up.
• Identify coding opportunities and make recommendations to improve internal controls and operational effectiveness and efficiency.
• Assist in preparation & development of provider training tools and lead and conduct educational and training programs for physician training on various aspects of documentation and ICD-10-CM coding.
• Perform review of specific provider/provider group medical records, develop audit reports and communicate audit results to external physician groups and physician group administration.
• Coordinate quality audit program reporting and provider coding training with appropriate areas within Medicare Advantage Risk Adjustment and promote teamwork.
• Responsible for the development and ongoing, end-to-end management of the quality audit program ensuring that QA activities and measurements are objective.
• Responsible for quality audit program performance and adherence to established ICD-10-CM and CMS-HCC coding guidelines, ensuring compliance with all regulations.
• Develop and maintain appropriate reporting, identifying metrics that will reflect true audit program performance.
• Gain management concurrence and support for recommended control improvements.
• Test and improve training program based upon experience and feedback.
• Gather information, constantly update knowledge on various changes that are happening in the field of quality audit and modify coding guidelines to incorporate new knowledge. Share changes with coders as well as physician practices partners.
• Manage multiple complex issues and projects simultaneously.
• Work collaboratively with other areas of Revenue Program Management to identify, implement and monitor continuous improvement opportunities.
• May require travel 0-25% of the time to Florida Blue office locations and provider engagements.

5+ years related work experience. Experience Details:
Professional coding including proficiency in ICD-10-CM coding guidelines and risk adjustment HCC coding. Related Bachelor's degree or additional related equivalent work experience. AAPC Certified Professional Medical Auditor (CPMA) certification. AAPC Certified Professional Coding Instructor (CPC-I) certification 1 Year. Knowledge of CMS-HCC risk adjustment data validation process. Organization and time management skills. Demonstrate written and verbal communication skills.

Knowledge of government regulations, requirements, and standards related to the management of health information. Knowledge of Scope and Statistical Sampling Methodologies. Detail-oriented, commitment to accuracy, ability to problem solve. Working knowledge of MS Office (Excel, Word, PowerPoint).

Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traveling activities are required only occasionally.

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally.

As a Florida Blue employee, you will thrive in our Be Well, Work Well, Guide Well culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and…