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

Here’s What You Need

Education

• High School Diploma or equivalent required.
• Associates Degree preferred.

Experience

• Require 3 years of Risk Adjustment Coding and Auditing or related experience,
• Highly prefer 1 year of Prior Coding Education and Training experience.

Licenses and Certifications

• Require a current professional coder certification (RHIT, RHIA, CAC, CPC, CPC-A, COC, CPC-P, CCS) with credentialing from AHIMA and/or AAPC and must be maintained annually, OR,
• Require Certified Risk Coder (CRC) Certification.

Skills & Abilities

• Strong knowledge of Microsoft Office products (Word, Excel, PowerPoint, etc.)
• Excellent analytical, organizational, and time management skills with the added ability to present information in front of groups of people.
• Thorough knowledge of CMS Medicare Advantage documentation and 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.

What You Will Do

Position Responsibilities

The Risk Adjustment Education Specialist is responsible for providing Risk Adjustment education and chart reviews for the SWHR Provider Network. This role will work directly with Providers to assist in achieving accurate and complete coding documentation and improving metrics.

Position Functions

• 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.
• Responsible for the collection and analysis of qualitative and quantitative data as it relates to Risk Adjustment specifically around prevalence and suspects.
• Contributes to the design and development of ad hoc reports and presentations for Risk Adjustment initiatives.
• 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.
• Develop and maintain strong working relationships with assigned SWHR clinic partners, including providers and support staff.
• Develops physician and staff remediation plans.
• Conduct audits on vendor coding platforms.
• 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.
• Meet with RAF leadership to partner on the Physician Risk Education Strategy.
• Speak and present at outreach events.
• Other duties as assigned.

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

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