Risk and Quality Provider Educator

Overview

Educates providers on Clinical documentation and Quality measures to ensure member's receive the care for all their chronic and acute condition, improve their quality of life and thus preventing complications and adverse events by performing education either remotely or in person by traveling to providers as needed. Reviews performance metrics, as well as patient charts, to identify areas of opportunity to support accuracy clinical documentation.

Works with Risk Adjustment and Quality team to identify topics, areas and opportunities for provider education. Supports the creation, maintenance, and enhancement of clinical documentation for providers.

What We Provide

* Referral bonus opportunities

* Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

* Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability

* Employer-matched retirement saving funds

* Personal and financial wellness programs

* Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

* Generous tuition reimbursement for qualifying degrees

* Opportunities for professional growth and career advancement

* Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

* Selected candidate will be awarded a one-time sign-on bonus of $7,000 in addition to base salary

What You Will Do

* Conducts educational needs assessment for provider practices and develops customized education plans for provider and coders at their practice locations.

* Travels between numerous provider offices across all regions to promote Quality of care, HEDIS and STARS measures and accurate ICD coding and accuracy for our members.

* Collaborates with Risk and Quality team in the development of an annual training calendar/workplan to ensure a coordinated approach to ongoing provider education programs.

* Designs and develops teaching plans and program content for provider education and ensure it meets contractual and regulatory requirements.

* Leads individual and group education sessions with Providers and/or their staff.

* Organizes training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc.

* Engages with medical practitioners to provide education, feedback and educational resources on best practices for ICD 10 CM Coding, accuracy and Quality measures.

* Ensures program content is presented in a manner that promotes learning thus improving accuracy supporting documentation for ICD 10 CM codes and Quality of care measures for our members.

* Keeps current on new ICD 10 CM Coding and Quality guideline, and educates team in new/changes to regulations.

* Reviews and evaluates ongoing provider education programs to identify areas for improvement. Presents improvement strategies to department leadership. Participates in the development of revised programs and/or materials in collaboration with Communications team.

* Maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.

* Utilizes resources and practices sound fiscal responsibility; provides input for the development of the department budget. Monitors expenditures and ensures compliance with budgetary constraints.

* Identifies performance issues that may arise, communicates to leadership, works on a plan with provider practices for improvement.

Qualifications

Licenses and

Certifications:

* Certified Professional Coder (CPC) or (CRC) Certified Risk Adjustment Coder or Certified Coding Specialist (CCS) required

* Additional coding certifications such as Certified Inpatient Coder (CIC) or Registered Health Information Technician (RHIT) in ICD-10-CM coding preferred

* Valid driver's license required

Education:

* Bachelor's Degree In Healthcare related field or relevant work experience required

* Master's Degree In Healthcare related field preferred

Work Experience:

* 5 years' experience in a role that includes subject matter expertise in HCC coding with Inpatient and outpatient medical records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required

* 2 years of experience in coding and/or clinical documentation education required

* Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits preferred

* Strong planning, organizational, interpersonal, verbal and written communication skills required

* Ability to handle multiple priorities and meet deadlines required

* Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required

* Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required

* Knowledge of computer applications required

* Ability to switch gears and independently collaborate with other…