National Coding Educator - Remote

UnitedHealth Group•Irvine, CA

9d•$91,700 - $163,700•Remote

About The Position

The National Coding Educator acts as a provider engagement specialist. This is a virtual position responsible for providing expertise in the area of risk adjustment and quality coding for provider clients. A National Coding Educator will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects, and monitoring of appropriate clinical documentation and correct coding. He/She will also coordinate implementation of programs designed to ensure all diagnoses are coded in accordance with CMS and risk adjustment coding guidelines and all conditions are properly supported by appropriate documentation in the patient chart. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Certified Risk Adjustment Coder (CRC) and either Certified Professional Coder (CPC) with AAPC or CCS-P with AHIMA with the requirement to obtain the AAPC Approved Instructor credential within 6 months
5+ years of coding training experience training providers, coders, and billers
4+ years of experience in Risk Adjustment and/or HEDIS/Stars Provider education
Experience working effectively with common office software, coding software, EMR and abstracting systems
Advanced proficiency in MS Office (Excel [Pivot tables, excel functions], PowerPoint and Word)
Must be willing to travel 30%-50% of the time for onsite training and education as business needs dictate
Must be able to provide proof of a valid, unrestricted Driver’s License and current Auto Insurance

Nice To Haves

Certified Professional Medical Auditor (CPMA) certification
4+ years of clinic or hospital experience and/or managed care experience
Experience in management position in a provider practice
Knowledge of EMR for recording patient visits
Knowledge of billing/claims submission and other related processes
Excellent oral & written communication skills
Experience giving group presentations
Strong business acumen and analytical skills
Ability to deliver training materials designed to improve provider compliance
Ability to develop long-term relationships
Good work ethic, desire to succeed, self-starter
Ability to use independent judgment, and to manage and impart confidential information

Responsibilities

Partners with Healthcare Advocates in the field to consult and educate providers and their staff based on data analysis where support / training is needed to improve documentation and coding accuracy
Supports providers in understanding CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation and diagnosis coding to ensure compliance
Utilizes analytics and identifies and targets providers for chart review
Utilizes analytics and identifies target providers for Medicare Advantage Risk Adjustment training and documentation and coding education
Facilitates and performs audits of the providers’ medical charts to ensure appropriate documentation that supports the diagnoses submitted
Ensures that provider documentation supports the submission of relevant ICD-10-CM and CPT II codes, when appropriate, in accordance with national coding guidelines
Routinely consults with medical providers to provide feedback regarding identified coding errors and omissions and deliver targeted coding education
Ensures member encounter data (diagnoses and quality care) is being accurately documented and relevant diagnosis and quality codes are being captured
Provides thorough, timely and accurate consultation on ICD-10-CM and/or CPT II coding by providers or practice clinical consultants
Provides ICD-10-CM and CPT II coding training to providers and appropriate staff
Develops and presents coding presentations and training to small and large groups of clinicians, practice managers and certified coders, customizing training to fit specific provider's needs
Develops and delivers diagnosis coding tools and quality reporting tools to providers, coders and billers
Trains physicians and other staff regarding documentation and coding and provides feedback to physicians regarding documentation practices
Educates providers and staff on coding regulations and changes as it relates to Risk Adjustment and Quality Reporting to ensure compliance with state and federal regulations
Performs analysis and provides formal feedback to providers as indicated or as requested
Provides measurable, actionable solutions to providers that will result in improved accuracy in documentation and coding practices
Reviews selected medical documentation to determine if diagnosis codes and quality reporting codes are appropriately assigned
Assesses adequacy of documentation and trains Provider office staff on Provider queries to clarify documentation to ensure accurate and complete coding
Collaborates with providers, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality Reporting education efforts
Participates in the interview and selection process for Optum Approved Trainers
Provides ongoing educational support for Optum Approved Trainers
Participates in Optum tool and presentation creation and in the annual update process to ensure timely completion and delivery of materials
Works with Optum Approved Trainers during annual tool and presentation updates
Facilitates and presents during the Optum National Coding Forum
Collaborates with fellow National Coding Educators on a regular basis