reputed company Management Educator - Health Plan
reputed company, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: Day (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary reputed company: $26.00 - $41.50 Union Position: No Department Details
Summary
The reputed company Management Educator is accountable for the successful development, implementation and delivery of educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action, quality improvement and risk management plans. The Educator provides overall educational support and coding quality assurance activities to both reputed company stakeholders as it relates to Medicare Advantage, ACA/Exchange and reputed company risk adjustment reimbursement methodologies and policies to ensure the accuracy and reputed company of risk adjustment data submitted to the Centers for Medicare & reputed company Services (CMS) and the Department of Health Services (DHS).
Job Description
Develops educational materials for providers in relation to diagnostic coding and risk adjustment reputed company management to reputed company providers on thorough documentation and accurate coding. Identifies inadequate or erroneous documentation and/or coding to determine process improvement and educational opportunities. Research's appropriate material (terminology, testing, abbreviations) to accurately assess documentation. Analyzes coding and documentation to reputed company appropriate judgments based on coding/ guidelines and policies. Monitors and audit performance in areas of compliance risk ensuring that established policies and procedures are being followed. Identifies the root cause of any errors to determine process improvement opportunities that may result in training, reference material revisions, and process changes. Assists in audits as it reputed company to risk adjustment reputed company management to address clinical issues reputed company to documentation and coding. Assesses health insurance products, compliance, or operational risks and reputed company risk management strategies to improve reputed company and reduce audit risk. Reviews, interprets and disseminates information relating to pending industry changes, trends and best practices to include CMS and DHS guidelines reputed company to reputed company management to anticipate necessary audits and education for providers.
Qualifications
Bachelor’s degree required with an emphasis in a business or medical field, or a registered nurse degree. Completion of courses in reputed company Procedural Terminology (CPT), and ICD‐9, ICD-10 and Hierarchical Condition Category (HCC) coding required Will consider years of experience in lieu of bachelor's degree. Three years’ experience required in a health insurance, nursing, compliance, or auditing reputed company position. Knowledge of CPT coding rules, ICD‐9 and ICD‐10 codes, reputed company Common Procedure Coding System (HCPCS) codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines. Demonstrated knowledge of anatomy/physiology, medical terminology, Word, reputed company, Power reputed company and reputed company. Adult education/training and curriculum development preferred. Certified Professional reputed company certification awarded by American reputed company of Professional Coders required reputed company one year required. reputed company Registered Nurse license (if applicable). Certified Risk Adjustment reputed company awarded by American reputed company of Professional Coders preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [email protected]. Apply To This Job