Risk Adjustment Education Specialist - Health Plan Admin - CHRISTUS Health

CHRISTUS Health System offers the Risk Adjustment Education Specialist position as a hybrid opportunity requiring 50%+ travel to regional locations. Candidate must reside within 60 miles of Santa Fe, NM, Tyler, TX or Beaumont, TX. 

Summary:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Subject matter experts for proper risk adjustment coding and CMS data validation.
• Work in conjunction with other departments, including Provider Relations, Quality, and the Medical Director, to ensure compliance with CMS risk adjustment guidelines.
• Analyze MRA data to identify patterns and development of provider and market-level interventions to coordinate an educational work plan for providers.
• Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and improve care quality.
• This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
• Responsible for building positive relationships with assigned Physicians and serving as a contact for any questions or concerns that may arise.
• Identify those Practices that need initial or ongoing additional training.
• Must be proficient in Prospective, Retrospective, and Concurrent review processes.
• This position does require the ability to have reliable transportation to conduct ongoing face-to-face interactions with Providers.
• Must have strong clinical knowledge of disease pathology and ability to identify clinical indicators related to chronic disease.
• Must be self-motivated: energetic, self-starter; can work autonomously with limited direction.
• Must be results-oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes.
• Must be analytical: vital research, writing, analytical, and critical reasoning skills.
• Must be a good communicator: conveys thoughts and expresses ideas concisely and effectively both verbally and in writing; strong presentation skills.
• Must be a good collaborator: orientation to team-based work product and results, open to change and process enhancement.
• Perform other duties as necessary.

Requirements:

• Associate degree or equivalent experience required.
• 5 years of experience in a hospital, a physician setting, or a Managed Care Organization as a medical coder required.
• 2 years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) required.
• Other experience in teaching, training, or an educator/instructor role is needed, but provider education experience is preferred.
• Must have experience in creating effective training materials and presentations (PowerPoint, Adobe, etc.)
• Licenses, Registrations, or Certifications
• Certified Professional Coder (CPC) from AAPC is required.
• Certified Risk Adjustment Coder (CRC) from AAPC is preferred.
• An RN or LVN must obtain both CPC and CRC within 12 months of hire.

Work Type:

Full Time

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