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Revenue Management Educator
Location
United States
Posted
12 days ago
Salary
$26 - $42 / hour
Seniority
Mid Level
Job Description
Revenue Management Educator
Sanford Health
Role Description The Revenue Management Educator is accountable for the successful development, implementation, and delivery of educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action, quality improvement, and risk management plans. The Educator provides overall educational support and coding quality assurance activities to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange, and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). - Develops educational materials for providers in relation to diagnostic coding and risk adjustment revenue management. - Identifies inadequate or erroneous documentation and/or coding to determine process improvement and educational opportunities. - Researches appropriate material (terminology, testing, abbreviations) to accurately assess documentation. - Analyzes coding and documentation to make appropriate judgments based on coding guidelines and policies. - Monitors and audits performance in areas of compliance risk ensuring that established policies and procedures are being followed. - Identifies the root cause of any errors to determine process improvement opportunities that may result in training, reference material revisions, and process changes. - Assists in audits related to risk adjustment revenue management to address clinical issues related to documentation and coding. - Assesses health insurance products, compliance, or operational risks and develops risk management strategies to improve revenue and reduce audit risk. - Reviews, interprets, and disseminates information relating to pending industry changes, trends, and best practices to include CMS and DHS guidelines related to revenue management. Qualifications - Bachelor’s degree required with an emphasis in a business or medical field, or a registered nurse degree. - Completion of courses in Current Procedural Terminology (CPT), ICD‐9, ICD-10, and Hierarchical Condition Category (HCC) coding required. - Bachelor of Science in Nursing preferred. - Three years’ experience required in a health insurance, nursing, compliance, or auditing related position. - Knowledge of CPT coding rules, ICD‐9 and ICD‐10 codes, Healthcare Common Procedure Coding System (HCPCS) codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines. - Demonstrated knowledge of anatomy/physiology, medical terminology, Word, Excel, PowerPoint, and Access. - Adult education/training and curriculum development preferred. - Certified Professional Coder certification awarded by American Academy of Professional Coders required within one year. - State of Wisconsin Registered Nurse license (if applicable). - Certified Risk Adjustment Coder awarded by American Academy of Professional Coders preferred. Company Description Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.
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