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Job Description:

Position Summary:  Responsible for educating and advising providers and practice staff in Medicare coding guidelines, focusing on revenue enhancement opportunities. Work in collaboration with other PHP departments and Optum/United HealthCare Medicare Advantage(MA) or other health plans to develop plans and materials that support education and system changes to meet practice and IPA revenue goals.

COMPETENCIES/Role-Specific Functions: 

COMMUNICATION

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

• Collaborates to develop plans and present to practices the HCC education program that reflects IPA ethical standards and Medicare guidelines. 
• Collaborate with Optum and PHP data analysts to develop meaningful practice-level reporting to assist in coding and code submission more effectively.
• Work with contracted Medicare Advantage plans, Optum and other third party vendors to drive or supplement educational forums and reports.

PROBLEM SOLVING

Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

• Identify potential data flow obstacles within assigned practices and work with practice staff to develop action plans to assist practices in overcoming obstacles.  Involve PHP Practice Transformation Coach to assist practices as needed. 
• Identify and solve issues with other vendors (billing companies, clearinghouse, etc.) to remove obstacles that prevent maximum code extraction and submission.

PRODUCTIVITY

Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.

• Risk adjustment chart reviews.
• Educate physicians and office staff on coding techniques to accurately document and capture patient acuity to the highest degree of specificity while maintaining Medicare guidelines.

SELF DEVELOPMENT

Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

• Maintains working knowledge of changing health industry environment related to the risk adjustment model and CMS expectations such as tolerance, fraud/abuse responses, etc.
• Remain current on CEUs to maintain CPC and other professional certifications.

CUSTOMER FOCUS

Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

• Be a primary resource for physicians and office staff to answer questions or access resources to support documentation and coding for risk adjustment. 
• Interface with assigned practices on a regular basis to help develop and maintain engagement levels of practices. 
• Build relationships with practices to help them understand the importance of documentation and coding in a manner that addresses overall patient care management and IPA revenue goals. 

JOB KNOWLEDGE

Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

• Other duties as assigned.

Qualifications (Education/Experience/Knowledge/Skills/Abilities): 

• Bachelors’ degree in health related field required. Four years of related work experience may be considered in lieu of a degree.
• Certified Professional Coder (CPC) required.
• Certified Risk Adjustment Coder (CRC) required or commitment to get within 1 year of employment.
• Three to five years’ experience with medical records and/or medical coding, preferably risk adjustment coding.
• Knowledge of health care insurance claims practice and compliance.
• Knowledge of Medicare rules and guidelines.
• Knowledge of Claims Coding (CPT, HCPCs, ICD-10, HCFA 1500).
• Knowledge of risk adjustment categories and hierarchy preferred.
• Knowledge of MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, other software programs and internet based applications as needed to fulfill position duties.
• Skilled in synthesizing data and questions to communicate a cohesive educational training program.
• Skilled in responding to practice inquiries in a timely and accurate manner.
• Skilled in working collaboratively with various parties to communicate an accurate and meaningful reporting package for practices.
• Able to work effectively with physicians, practice staff, health plan/other external parties and PHP multidisciplinary team to streamline efforts to meet HCC Coding goals.
• Able to work with sensitive data and relay potential issues or concerns in a diplomatic manner.
• Able to multi-task and meet deadlines.
• Able to work with external parties to obtain resources as needed.
• Able to communicate findings in a clear, concise manner, both internally and externally, including presentations.
• Required Licensure or Certification for this position must be maintained by the employee as defined by the company policies and procedures.

• A valid unrestricted Colorado drivers’ license. 
• Reliable and insured vehicle.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures. 
• Mobile Device for work purposes as defined by the company policies and procedures.

Salary Range:

$59,155 - 78,884