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

Education

• High School diploma or equivalent required.
• Associates degree or 2 years of additional experience required.
• Bachelor’s degree or 4 years of additional experience required.

Experience

• Require 2 years of Hierarchical Condition Category (HCC) coding experience with Bachelor’s degree, or,
• Require 4 years of HCC coding experience with Associate degree, or,
• Require 6 years of HCC coding experience with High School Diploma or equivalent.

Licenses and Certifications

• Require a current Certified Professional Coder (CPC) Certification from the American Academy of Professional Coders (AAPC) upon hire date.
• Prefer Certified Risk Coder Certification.

Skills & Abilities

• Ability to communicate and interact positively and professionally throughout all levels of the organization and with external customers.
• Strong organizational skills in multiple settings, as well as the ability to exercise sound judgment and initiative.
• Strong presentation skills.
• Excellent problem solving and the ability to handle multiple projects, heavy workloads and deadlines in a fast-paced dynamic environment.
• Self-motivated with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member.
• Strong working knowledge of MS Office products, including PowerPoint, Excel and Word; Adobe Captivate, Articulate and/or MLS relational database knowledge desired.
• Ability to think strategically to develop new initiatives/processes that will achieve our specified targets.
• Provide clear, appropriate and timely communication to promote a team environment throughout the department.
• Ability to motivate team and hold team accountable for the results.
• Ability to work effectively as an interdisciplinary team as well as independent.
• Excellent knowledge of file transfer and audit processes as they relate to Risk Adjustment and Quality.

Position Responsibilities

The Risk Adjustment Education Specialist assists in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects. Identifies opportunities to improve accuracy and completeness for revenue impact. Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives. Meet with RAF leadership to partner on Physician Risk Education strategy. Assist with the development and utilization of training and attendee tracking metrics and methodologies. Assist with the development of physician and staff coding remediation plans. Monitor education programs, timelines, learner progress and report to leadership when appropriate.  Provides onsite instruction per location (practice/clinic) for physician practice and office staff with ICD-10-CM coding training focusing on Medicare Risk Adjustment documentation and coding opportunities. Provides instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment-type diagnosis codes. Performs education and chart review on all RAF initiatives. Speak and present at outreach events and functions.

Position Functions

• Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects.
• Identifies opportunities to improve accuracy and completeness for revenue impact.
• Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives.
• Meet with RAF leadership to partner on Physician Risk Education strategy.
• Assist with the development and utilization of training and attendee tracking metrics and methodologies.
• Assist with the development of physician and staff coding remediation plans.
• Monitor education programs, timelines, learner progress and report to leadership when appropriate.
• Provides onsite instruction per location (practice/clinic) for physician practice and office staff with ICD-10-CM coding training focusing on Medicare Risk Adjustment documentation and coding opportunities.
• Provides instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment-type diagnosis codes.
• Performs education and chart review on all RAF initiatives.
• Speak and present at outreach events.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org