Value Based Care Coder Educator
Value Based Care Coder Educator
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Salary Not Disclosed
1 Vacancy
Job Description
Responsible for abstracting medical record diagnosis codes based on clinical documentation adhering to ICD10CM Official Guidelines for Coding and Reporting AHA Coding Clinic guidance CMS program regulations and relevant federal and state laws rules and UMMS policies and procedures. Implement coding guidance for various programs including Commercial Risk Adjustment Medicare Advantage Risk Adjustment Commercial IVA (Initial Validation Audit) Medicaid HHSHCC Commercial DxCG and OPPS (Outpatient Prospective Payment System) for claims reimbursement and medical necessity. Work is performed under limited supervision. Direct report to the Senior Manager Risk Adjustment.
Primary Responsibilities
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.
Perform code abstraction of medical records to ensure ICD10CM 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 ICD10CM 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 including CMSHCC (Medicare) HHSHCC (Medicaid) DxCG (Commercial) and OPPS (grouper methodologies).
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.
Qualifications :
Education & Experience Required
Associates 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 (CMSHCC HHSHCC 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 CCSP).
Education & Experience Preferred
Not Applicable
Knowledge Skills & Abilities
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.
Selfmotivated 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 problemsolving 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..
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Compensation
- Pay Range:$33.36$46.7
- Other Compensation (if applicable):
- Review theUMMS Benefits Guide
This is a fully remote position.
Like many employers UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details personal identification or payment via email or text. If you suspect fraud please contact us at
Remote Work :
Yes
Employment Type :
Fulltime
Employment Type
Remote
Company Industry
Key Skills
- Early Childhood Education
- Algebra
- Classroom Experience
- Lesson Planning
- Special Education
- Adult Education
- Special Needs
- Calculus
- Teaching
- Geometry
- Experience with Children
- Public Speaking
