Provider Coding Educator

The Provider Coding Educator is responsible for supporting and tracking RAF / HCC and coding education for clinical providers. This role will identify and support providers who would benefit from Medicare risk adjustment training.

• preparing and conducting provider education training, materials, chart reviews, creating feedback reports, etc.
• Help design an education program that is tailored to the needs of the providers including determining the best method for interacting with providers.
• Implement education and provide formal training to providers and staff as needed regarding coding compliance, documentation guidelines, HCC education, and Medicare / Medicaid regulations.
• Educating providers on documentation improvement for compliance and optimum patient quality of care.
• Provide feedback and present solutions to the Leadership Team of Performance Programs for general and individual provider education. Helps in creating policies and procedures for monitoring reviews, queries, query tracking, education, and interaction with providers.
• Conforms with accepted standards of conduct in provider education and ethical queries.
• Educating providers on documentation to accurately reflect the patients overall health status.
• Develop customized provider-specific plans to improve documentation.
• Conduct provider chart reviews as needed to aid in provider education.
• Implement education and provide formal training to providers and staff as needed regarding coding compliance, documentation guidelines, HCC education, and Medicare / Medicaid regulation.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations.
• Schedule provider education sessions independently or in collaboration with Network Management.
• Develop and maintain provider education tracking database.
• Training providers on RAF methods and tools and working toward compliance.
• Utilize management for escalation purposes.
• Maintain strictest confidentiality based on HIPPA policies.
• Local travel to provider offices in Los Angeles, Orange County, Inland Empire, and San Diego up to 70%
• Other duties as assigned.

Three (3) years of experience in healthcare including provider relationship management, ICD9 / 10 coding preferred. Experience in a clinical setting is school diploma or equivalent , CCS, CCS-P, or other recognized coding certification from accredited source (., American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.