Risk-Adjustment Coding Educator

10000 Sanford; United States; On-site; USD 74,501,000 - 118,804,000; Full time

Job summary

Sanford Health is seeking a Revenue Management Educator to develop and deliver educational materials that improve coding accuracy for Medicare Advantage, ACA/Exchange and Medicaid risk adjustment. You will implement strategic action plans and quality improvement initiatives to support providers in proper documentation and coding practices.

The educator will conduct audits, address documentation gaps, and disseminate CMS and DHS guidelines to anticipate audits and education needs.

Qualifications

• Bachelor’s degree required with an emphasis in a business or medical field, or a registered nurse degree.
• Completion of CPT, ICD-9, ICD-10 and HCC coding courses; years of experience may substitute degree.
• Three years’ experience in health insurance, nursing, compliance, or auditing.
• Knowledge of CPT rules, ICD-9/ICD-10, HCPCS, HCC, modifiers, and CMS policy requirements.
• Anatomy/physiology, medical terminology, Word, Excel, PowerPoint and Access knowledge.
• Adult education/training and curriculum development preferred.
• CPC certification within one year required.
• Wisconsin RN license if applicable.
• CRAC preferred.

Responsibilities

• Develops educational materials for providers related to diagnostic coding and risk adjustment to educate on documentation and accurate coding.
• Identifies inadequate documentation and/or coding to determine improvement opportunities.
• Researches material to accurately assess terminology and coding.
• Analyzes coding to make judgments based on guidelines and policies.
• Monitors and audits performance to ensure policy compliance.
• Identifies root causes of errors to drive training and material revisions.
• Assists in audits related to risk adjustment to address clinical issues.
• Assesses health insurance products and risks to improve revenue and reduce audit risk.
• Reviews industry changes and CMS/DHS guidelines to anticipate audits and education.

Skills

CPT coding rules

ICD-9/ICD-10 coding

HCPCS coding

Anatomy & physiology

Adult education/training

Documentation guidelines

CMS policy knowledge

Risk adjustment basics

Education

Bachelor’s degree in business or medical field

Registered Nurse degree

Certified Professional Coder (CPC) certification

Certified Risk Adjustment Coder (CRAC) preferred

Tools

Word

Excel

PowerPoint

Access

Job description

Sanford Health is seeking a Revenue Management Educator to develop and deliver educational materials that improve coding accuracy for Medicare Advantage, ACA/Exchange and Medicaid risk adjustment. You will implement strategic action plans and quality improvement initiatives to support providers in proper documentation and coding practices.

The educator will conduct audits, address documentation gaps, and disseminate CMS and DHS guidelines to anticipate audits and education needs.