Risk Adjustment Coding Educator

Description

The healthcare system isn’t designed for health. We’re designed to change that.  

We’re Wellvana, and we help doctors deliver life-changing healthcare.  

Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it. 

Our enlightened approach—covering everything from care coordination to coding to marketing— ties the healthy outcomes of patients directly to healthier earnings for primary care providers.  

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated 24/7 care that is nothing short of life changing.  

Recently named by Insider as one of 33 startups “investors expect to take off in 2023,” we’re one of the fastest-growing healthcare companies in America because what we do works.  

This is the way medicine is meant to be.

The Role:

The Risk Adjustment Provider Educator educates Providers on all aspects of risk adjustment coding, regulatory requirements, and proper documentation procedures for MA, MSSP, ACO Reach, DCE patients. Identify coding trends and documentation patterns from data retrieved by coding reviews and audits, tailoring education accordingly.  Educator must have a thorough understanding of the purpose of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy and be able to communicate this knowledge effectively to Providers.  Follow-up educations and coding improvement tracking. Distribution of any training materials needed. Knowledge of how to identify unreported conditions and instruct providers how to readdress open chronic conditions. Responsible for building positive relationships with assigned Physicians and serve as a contact for any questions or concerns that may arise. Identify those Practices that need initial or ongoing additional training. Must be proficient at Prospective, Retrospective and Concurrent review processes. Reports directly to Director of Auditing. This position does require the ability to have reliable transportation in order to conduct ongoing face-to-face interactions with Providers. Educator will be required to frequently travel to regional offices. 

Responsibilities:

• Educate providers on risk adjustment: its purpose, CMS-HCC coding rules and guidelines, open condition reporting, identifying unreported conditions, proper documentation for MA, MSSP, ACO Reach, and DCE patients
• Able to perform and educate providers on Prospective, Retrospective, and Concurrent review processes
• Build and maintain professional relationships with providers and their staff within assigned region, performing ongoing face to face visits to assigned offices 
• Distribute company provided educational materials and coding tools, guide providers to utilize customized technology to identify missed possible conditions for their patients. 
• Collaborate with Practice Transformation Specialist, Audit and coding teams, Market Operation Leads regarding all provider specific educations
• Identify any error trends in provider documentation and coding by analyzing data derived from coding reviews and internal audits results. Abstract any training opportunities from data set. Consult with providers and billing staff to correct errors found. 
• Responsible for distributing any claims corrections needed and provider documentation queries. Perform post audits on any action items to assure compliance
• Track improvements in provider coding Quality scores resulting from ongoing educations
• Region specific special projects as assigned by Director of Auditing

Requirements

• Knowledge of Risk Adjustment Coding, CMS-HCC Hierarchy Model coding, Industry Rules and Regulations and the ability to communicate that knowledge effectively to providers in individual and group settings
• Certified Coder – required CPC, CRC preferred CPMA
• 3 years minimum experience with Risk adjustment coding and documentation improvement queries
• Ability to identify any potential areas of Fraud and Abuse regarding coding and documentation, according to regulatory agency guidelines
• Ability to conduct comprehensive chart reviews as needed
• Microsoft Office presentation proficiency 
• Strong attention to detail and strong analytic skills
• Experience in closing Performance and Coding Gaps
• Ability to travel