Risk Adjustment Education Specialist - Risk Adjustment, Southwestern Health Resources (SWHR)

Southwestern Health Resources; Dallas (TX); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Southwestern Health Resources is seeking a Risk Adjustment Education Specialist to provide education, chart review, and training to assigned practices. Travel to provider sites is required as needed, with a hybrid work arrangement allowed at manager's discretion.

You will analyze data related to Risk Adjustment, support reporting initiatives, and act as a coding and education expert for Medicare Risk Adjustment documentation. Strong collaboration with clinics and leadership is essential.

Qualifications

• Strong knowledge of Microsoft Office products (Word, Excel, PowerPoint, etc.).
• Excellent analytical, organizational, and time management with the ability to present information to groups.
• Thorough knowledge of CMS Medicare Advantage documentation/submission policies and ICD-10-CM coding guidelines.
• Ability to manage multiple tasks and projects and forge strong working relationships.
• Ability to communicate clearly and effectively, both orally and in writing.

Responsibilities

• Provide Risk Adjustment education, chart review, and training to assigned practices; travel onsite as needed.
• Analyze qualitative and quantitative data related to Risk Adjustment, including prevalence and suspects.
• Assist in design and development of ad hoc reports and presentations for Risk Adjustment initiatives.
• Serve as Risk Adjustment documentation and coding expert; address questions for clinics and review ICD-10-CM translations.
• Develop and maintain relationships with clinic partners; collaborate with leadership on strategy.
• Coordinate education services, onboarding activities, and learner progress tracking.

Skills

MS Office

Analytical skills

Time management

ICD-10-CM coding

Communication

Relationship building

Education

HS Diploma

Associate's Degree

Job description

Southwestern Health Resources is looking for a highly skilledRisk Adjustment Education Specialist. Is that you?

Work Hours:Full Time Days (8:00am-5:00pm) for 40 hrs/week (hybrid work allowed at manager's discretion)

Department Highlights:

• Hybrid Position
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
• Contribute and work on a cross functional team

What You Will Do:

Responsible for providing Risk Adjustment education, chart review, and training to assigned practices must be willing to travel onsite. Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data . 20%
Responsible for the collection and analysis of qualitative and quantitative data as it relates to Risk Adjustment specifically around prevalence and suspects . 20%
Contributes to the design and development of ad hoc reports and presentations for Risk Adjustment initiatives . 15%
Acts as Risk Adjustment documentation and coding expert, monitoring and answering questions for assigned clinics. Provides an instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment coding. Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned . 10%
Develop and maintain strong working relationships with assigned SWHR clinic partners, including providers and support staff. 5%
Develops physician and staff remediation plans. 5%
Conduct audits on vendor coding platforms. 5%
Responsible for tracking, scheduling, and coordinating all education services, including onboarding activities for Risk Adjustment coding and documentation. Monitor education programs, timelines, and learner progress and report to leadership when appropriate. 5%
Meet with RAF leadership to partner on the Physician Risk Education Strategy . 10%
Speak and present at outreach events, and other duties as assigned. 5%

What You Need:

Education
H.S. Diploma or Equivalent Req Or
Associate's Degree Pref
Experience
3 Years Risk Adjustment Coding and Auditing or related experience Req and
1 Year Prior Coding Education Pref
Licenses and Certifications
CPC - Certified Professional Coder with credentialing from AHIMA and/or AAPC (RHIT, RHIA, CAC, CPC, CPC-A, COC, CPC-P, CCS) Upon Hire Req Or
Other CRC-Certified Risk Coder from AAPC Upon Hire Req
Skills
Strong knowledge of Microsoft Office products (Word, Excel, PowerPoint, etc.)
Excellent analytical, organizational, and time management with the added ability to present information in front of groups of people.
Thorough knowledge of CMS Medicare Advantage documentation/submission policies and ICD-10-CM coding guidelines.
Ability to manage multiple tasks and projects and forge strong working relationships.
Ability to communicate clearly and effectively, both orally and in writing.
Supervision
Individual Contributor
ADA Requirements
Extreme Heat 1-33%
Extreme Cold 1-33%
Extreme Swings in Temperature 1-33%
Extreme Noise 1-33%
Working Outdoors 1-33%
Working Indoors 67% or more
Mechanical Hazards 1-33%
Electrical Hazards 1-33%
Explosive Hazards 1-33%
Fume/Odor Hazards 1-33%
Dust/Mites Hazards 1-33%
Chemical Hazards 1-33%
Toxic Waste Hazards 1-33%
Radiation Hazards 1-33%
Wet Hazards 1-33%
Heights 1-33%
Other Conditions 1-33%
Physical Demands
Sedentary

Additional Information

• Job Field: Clerical/Admin
• Shift: Day Job
• Schedule: Full-time

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