Risk Adjustment Auditor and Physician Educator- Remote, WA

Position: Risk Adjustment Auditor and Physician Educator- Remote, WA only
JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE:

Risk Adjustment Auditor and Physician Educator

JOB OVERVIEW:
The Risk Adjustment Auditor and Physician Educator is responsible for developing the process and reporting for performing annual, period, and other quality assurance reviews of medical record documentation and coding to ensure appropriate capture of Hierarchical Condition Categories (HCC) conditions. This position utilizes expertise and national coding guidelines as reference in performing medical record coding audits and in partnership with the Physician Champion, develops strategies for provider education and training.

DEPARTMENT:
Health Information Management

WORK HOURS:

Monday - Friday, typically 8:00 AM - 4:30 PM. Flexibility may be required to meet department and organization needs.

REPORTS TO:

Director HIM and Revenue Integrity

PREREQUISITES:

* Bachelor's degree in health sciences, health management or related field or equivalent related health experience required.

* Minimum 3 years of experience in risk adjustment coding and medical record review.

* Minimum 3 years of experience delivering education and training to Physicians required.

* Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required.

* Certified Risk Adjustment Coder (CRC) required.

* Certified Professional Medical Auditor (CPMA) strongly preferred.

* Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook.

QUALIFICATIONS:

* In depth clinical understanding of chronic disease management.

* Demonstrated proficiency in Medicare Risk Adjustment methodologies and ICD-10 coding concepts.

* Experience in health systems operations including knowledge of value-based methodologies, payer reimbursement and coding conventions.

* Demonstrated continuous learning in clinical medicine; practical understanding of ICD-10-CM/PCS and ability to educate physicians on the merits of best practice documentation strategies.

* Demonstrated ability to interpret national documentation and coding guidelines and translation to effective auditing practices and tools.

* Demonstrated ability to identify issues in documentation and coding practices and develop plan to remediate.

* Demonstrated ability to meet deadlines, with good time management and prioritization skills.

* Self-motivated and able to work independently.

* Demonstrated ability for critical thinking skills, with focus on assessment, evaluation, and teaching.

* Strong organization and analytical thinking skills; detail oriented.

* Strong verbal, written and presentation skills.

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS

* Must possess ability to work independently, with a minimum of direction, and take initiative in problem solving.

* Must be able to interact professionally and effectively with a wide variety of people, including operations staff, providers, the general public, and departments in Valley Medical Center (VMC).

* Requires typing, legible handwriting and computer/keyboard skills.

* Regular and punctual attendance is a condition of employment.

* Requires the ability to maintain self-composure and a positive attitude under stress.

* Requires problem solving and coaching ability and effective resolution of conflicts.

* Must be able to function effectively in an environment with frequent interruptions and multiple tasks.

PERFORMANCE RESPONSIBILITIES:

* Generic

Job Functions:

See Generic

Job Description for Administrative Partner.

* Essential Responsibilities and

Competencies:

* Conduct medical record audits and quality assurance reviews related to Hierarchical Condition Categories (HCC) condition coding.

* In collaboration with the Physician Champion, develop and deliver education and training on HCC coding guidelines and policies.

* In collaboration with the Physician Champion and Medical Directors, assist in developing strategies to improve overall coding accuracy and compliance.

* Provide ongoing feedback to physicians regarding HCC coding guidelines and requirements.

* Facilitate educational in-services for physicians and other providers related to HCC coding and documentation compliance.

* Create and analyze reports related to trending and ongoing monitoring for coding improvement.

* Monitor coding prevalence reporting for coding outliers.

* Monitor responsiveness of physician queries and education engagement with focus on continuous improvement, providing outcome feedback and opportunities to physician leadership.

* Identify any barriers to completion of documentation goals with appropriate interventions.

* Engage with provider specialties to identify clinical documentation improvement initiatives, effectively tailoring…