Risk and Quality Provider Educator

Travels to provider practice locations to educate providers on Clinical documentation and Quality measures to ensure member's receive the care for all their chronic and acute condition, improve their quality of life and thus preventing complications and adverse events. Reviews performance metrics, as well as patient charts, to identify areas of opportunity to support accuracy clinical documentation. Works with Risk Adjustment and Quality team to identify topics, areas and opportunities for provider education. Supports the creation, maintenance, and enhancement of clinical documentation for providers.

What We Provide

Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
Employer-matched retirement saving funds
Personal and financial wellness programs?
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care??
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement?
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities??
What You Will Do

Conducts educational needs assessment for provider practices and develops customized education plans for provider and coders at their practice locations.
Travels between numerous provider offices across all regions to promote Quality of care, HEDIS and STARS measures and accurate ICD coding and accuracy for our members.
Collaborates with Risk and Quality team in the development of an annual training calendar/workplan to ensure a coordinated approach to ongoing provider education programs.
Designs and develops teaching plans and program content for provider education and ensure it meets contractual and regulatory requirements.
Leads individual and group education sessions with Providers and/or their staff.
Organizes training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc.
Engages with medical practitioners to provide education, feedback and educational resources on best practices for ICD 10 CM Coding, accuracy and Quality measures.
Ensures program content is presented in a manner that promotes learning thus improving accuracy supporting documentation for ICD 10 CM codes and Quality of care measures for our members.
Keeps current on new ICD 10 CM Coding and Quality guideline, and educates team in new/changes to regulations.
Reviews and evaluates ongoing provider education programs to identify areas for improvement. Presents improvement strategies to department leadership. Participates in the development of revised programs and/or materials in collaboration with Communications team.
Maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
Utilizes resources and practices sound fiscal responsibility; provides input for the development of the department budget. Monitors expenditures and ensures compliance with budgetary constraints.
Identifies performance issues that may arise, communicates to leadership, works on a plan with provider practices for improvement.
Qualifications
Licenses and Certifications:

Certified Professional Coder (CPC) or Certified Inpatient Coder (CIC) required and
Certified Coding Specialist (CCS) or (CRC) Certified Risk Adjustment Coder or Registered Health Information Technician (RHIT) in ICD-10-CM coding required
Valid driver's license required
Education:

Bachelor's Degree In Healthcare related field or relevant work experience required
Master's Degree In Healthcare related field preferred
Work Experience:

5 years' experience in a role that includes subject matter expertise in HCC coding with Inpatient and outpatient medical records, including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required
2 years of experience in coding and/or clinical documentation education required
Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits preferred
Strong planning, organizational, interpersonal, verbal and written communication skills required
Ability to handle multiple priorities and meet deadlines required
Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required
Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required
Knowledge of computer applications required
Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.