HYBRID - Risk Adjustment Education Specialist
Department: FCC - Case Mgmt
Entity: FirstCarolinaCare
Job Category: Professional
Employment Type: Full - Time
Job ID: 45484
Experience Required: 1 - 3 Years
Education Required: Not Indicated
Shift: Day
Location: Southern Pines, NC
Usual Schedule: M-F; 9am-5pm
On Call Requirements: None
Work Location: FCC Southern Pines
Weekend Requirements: None
Holiday Requirements: None
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Position Summary:
The Risk Adjustment Education Specialist consults with providers and their office staff on a routine basis to ensure open communication and knowledge of risk adjustment initiatives, particularly related to coding accuracy and quality improvement. Serves as coding subject matter expert and assists and/or liaises for internal and external customers. Works collaboratively with Coding Analysts, Coding Supervisor, Manager, Director, and Medical Director to strategically plan and execute Risk Adjustment coding efforts for accuracy and risk mitigation, as well as identify areas for, and implement process improvement. Conducts, as necessary, all presentations to provider groups, individual providers, and others for risk adjustment education. Develops media outreach in collaboration with senior coding consultant and manager.
Qualifications:
EDUCATIONAL REQUIREMENTS Bachelor's Degree or Experience in Lieu of Education - Four (4) years experience in lieu of degree with heavy emphasis on provider interaction related to coding and clinical documentation, improvement, and education. CERTIFICATION & LICENSURE REQUIREMENTS Certified Coding Specialist (AHIMA) Certification must be maintained with required continuing education (CEUs). within 1 year or Registered Health Information Tech (AHIMA) Certification must be maintained with required continuing education (CEUs). within 1 year or Registered Health Information Admin (AHIMA) Certification must be maintained with required continuing education (CEUs). within 1 year or Certified Professional Coder (AAPC) Certification must be maintained with required continuing education (CEUs). within 1 year or Certified Inpatient Coder (AAPC) Certification must be maintained with required continuing education (CEUs). within 1 year or Certified Outpatient Coder (AAPC) Certification must be maintained with required continuing education (CEUs). within 1 year or Certified Risk Adjustment Coder (AAPC) Certification must be maintained with required continuing education (CEUs). within 1 year. EXPERIENCE REQUIREMENTS Two (2) years experience with bachelor's degree. Four (4) years experience in lieu of degree with heavy emphasis on provider interaction related to coding and clinical documentation, improvement, and education. Technical coding skills required. SKILLS AND KNOWLEDGE Possess software skills, particularly with Microsoft Office. Must project a professional, pleasant image while interacting with a variety of personalities at all levels, both in person and telephonically. Strong written and verbal communication skills and be adept at persuasion and problem solving. Ability to work independently, manage multiple tasks, be able to prioritize to achieve goals, and project confidence in all situations. Ability to coach and mentor others, modeling Carle Behavior Standards. Must have or obtain all necessary technical coding expertise as it relates to nomenclatures of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Groups (DRGs), and Internal Classification of Diseases. Must also be familiar with regulatory guidelines and their application to technical coding.
Essential Functions:
Collaborates with Senior Coding Consultant, Coding Analysts, Coding Supervisor and Manager to strategically plan and execute coding efforts (targeting, key messaging, publications, website updates, provider reports, electronic medical record prompts, etc.).
Serve as a subject matter expert in the risk adjustment models and processes.
Collaborates with necessary departments to ensure, when appropriate priority HCC coding activities are included on any and all provider, joint venture, departmental, etc. meeting agendas. Conducts necessary presentations.
Serves as a coding subject matter expert and coding consultant for Health Alliance Medical Plans. Conducts coding orientation, education, and monitoring for new and existing providers and other appropriate internal and external customers. Ensures adherence and maintains/submits necessary documentation associated with offering continuing medical education (CME) credits.
Assists with retrospective and prospective medical record reviews and auditing as requested.
Attends, as necessary, revenue management/ provider relations related conferences either in person or remotely.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.