Value Based Care Coder Educator

Associate’s degree in healthcare, or related field, or the equivalent combination of education, training, and experience. 3+ years’ experience in Medicare or Medicaid Risk Adjustment models (CMS-HCC, HHS-HCC, and DxCG risk adjustment methodology. Experience with EPIC, Cerner and/or NextGen. Certified Risk Coder certification from AAPC. One of the following certifications from AHIMA or AAPC preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS or CCS-P). Working knowledge of risk adjustment coding/billing/documentation workflows. Working knowledge of healthcare metrics. Advanced knowledge of the Affordable Care Act and its impact on Total Cost of Care and Value Based Care. Ability to think strategically, understand functional structures, manage project work, and generate innovative and practical solutions to complex or unusual problems. Advanced skill running, interpreting, and creating reports in Excel SharePoint, etc. Advanced customer service and client facing skills. Advanced skill developing and maintaining collaborative working relationships with all levels of leadership, team members and vendors. Self-motivated individual who can excel with little supervision and the proven ability to be successful in a fast paced, dynamic environment. Advanced skill presenting findings, conclusions, alternatives, and information clearly and concisely at all levels within the organization. Ability to analyze, compare, contrast, and validate work with keen attention to detail. Advanced analytical, critical thinking, planning, organizational, and problem-solving skills. Keen sense of personal responsibility and accountability for delivering high quality work. Advanced verbal, written, and interpersonal communication skills. Advanced skill in the use of Microsoft Office Suite (e.g., Word, Excel, PowerPoint.).

Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education. Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes. Maintain knowledge of and ensure compliance with ICD-10-CM codes, CMS documentation requirements, and applicable federal and state, laws, rules and regulations. Consistently maintain a minimum of 95% accuracy on coding quality audits. Meet minimum productivity and quality requirements as outlined by the project terms. Assist with individual and/or group education with healthcare providers as directed by the Senior Manager, Risk Adjustment. Participate in developing, maintaining and meeting key performance indicators as defined in the Risk Adjustment Project Plan annually. Maintain and update the Risk Adjustment Project Plan annually. Stay abreast of trends and regulations to ensure effectiveness and compliance of the Risk Adjustment programs. Assist with quality assurance tools and processes. Establish an understanding of the PHSO Risk Adjustment Project Plan and its interdependency on the PHSO Strategic Plan. Participate and assist with preparation for meetings including but not limited to internal PHSO, payer, practice, etc. Establish and maintain collaborative relationships with all levels of leadership, staff, and vendors. Perform other duties as assigned.