Medicare Risk Adjustment Educator – Hartford, CT

Job Title: Medicare Risk Adjustment Educator

Location for Hire: Hartford, CT

Exempt Status: Non-Exempt

Division: Coding

Reports to: Manager, Coding

Episource, with over 3,000 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.

Summary: 

The Medicare Risk Adjustment Educator is responsible for identifying opportunities to improve provider documentation and creating a customized education plan tailored to each assigned provider. In this role, the Educator will integrate with the on-site staff to review medical records and arrange educational sessions with the provider aimed at quality of care and documentation improvements.

Responsibilities:

  • On-site review and analysis of provider documentation with an eye toward compliance with CMS rules and regulations to capture risk adjusting (HCC) diagnoses
  • Develop a customized education plan for each assigned provider to address opportunities for clinical document improvements identified during the review
  • Provide one-on-one instruction with providers to address concepts identified by the Educator
  • Integrate with the provider and their staff to identify process improvement opportunities

Skills and Competencies:

  • Experienced Medicare Risk Adjustment (HCC) coder with a strong knowledge of ICD-10-CM diagnostic coding
  • Possess excellent written, verbal, and interpersonal communication skills
  • Experience providing feedback and gaining buy-in for recommendations
  • Demonstrated ability to gather and analyze data to identify trends
  • Proven track record of risk adjustment coding accuracy
  • Familiarity with common EMR applications and proficient in Microsoft Office (Word, PowerPoint, Excel)
  • Team-player with excellent time management, self-motivation, problem-solving, and attention to detail

Qualifications:

  • HS Diploma/GED required; AA degree or higher preferred or equivalent job-related experience
  • Possess at least one of the following professional certifications: CPC, CRC, CCS, CCS-P, RHIT, RHIA; CPMA and/or CPC-I is a plus
  • Minimum of 4 years of HCC coding experience
  • Minimum of 2 years of direct provider interaction
  • Travel required, at times within a 30-50 mile radius is expected
  • A valid driver’s license and insurance/liability policy in the employee’s name is mandatory in applicable cities/states when a motor vehicle is necessary for the position. Management will notify such employees when applicable

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is frequently required to stand, walk, sit and lift. The employee must lift, carry and/or move medical records weighing up to 10 pounds. The Employee must have the ability to engage in repetitive motions such as utilizing a computer and reviewing medical records. Specific vision abilities required by this job include color vision. Requires prolonged sitting, some bending, stooping and stretching, requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports.

 

EEO POLICY STATEMENT:

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.