Medical Record Training Consultant

Elevance Health•Atlanta, MO

3d•Hybrid

About The Position

Provides oversight of medical record coding and documentation review activities to support compliance with federal requirements and medical documentation standards. Delivers audit findings and insights to healthcare providers and stakeholders, while supporting provider education initiatives focused on Medicare risk adjustment coding accuracy, documentation quality, and regulatory compliance.

Requirements

Requires BA/BS in health sciences, health management, or nursing and minimum of 5 years of ICD-9 coding or medical record review experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.
CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.

Nice To Haves

Experience with Medicare Advantage and risk adjustment programs, including HCC coding.
Experience auditing physician, outpatient, and/or hospital medical records.
Experience interpreting and applying ICD-10-CM, CPT, HCPCS, and CMS guidelines.
Experience developing and delivering provider or staff education.
Strong knowledge of: CMS regulations and Medicare risk adjustment methodologies Medical record documentation standards Federal healthcare compliance requirements Coding and reimbursement principles
Ability to analyze audit findings, identify trends, and recommend corrective actions.
Strong written and verbal communication skills, including the ability to present audit results and educate providers.
Proficiency with Microsoft Office applications and reporting tools.

Responsibilities

Serves as final arbiter regarding the Risk & Recovery’s Retrospective Risk Adjustment (RA) Coding Team.
Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements
Collects and analyzes data to formulate recommendations and solutions based on trends and results
Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps
Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices
Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education
Assists the business with research and documentation of workflows and policies and procedures