Role Description 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. Primary 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. Qualifications - 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. Preferred Qualifications - 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. Soft Skills - 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. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Salary The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.