Risk Adjustment Auditor Educator Fully Remote

Employment Type: Full timeShift: Description: Rist Adjustment experience. Ability to conduct Education if needed. Auditing ExperiencePosting Job Description POSITION PURPOSE: A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding and documentation in alignment with risk adjustment models, conducting audits with analysis of trends, and providing education to providers and coders. They work to improve documentation quality, identify coding discrepancies, and ensure compliance with regulations as well as supporting SJH, CNY AIM and Trinity Health’s risk adjustment and payer value-based plan initiatives to support revenue and compliance standards in our provider group. SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE: Risk adjustment coding, provider auditing and clinical/education experience required. Must have 5 or more years’ experience as a risk adjustment auditor and educator and/or clinical documentation improvement specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well as a deep understanding of CMS guidelines, and other regulatory requirements are essential. Strong communication, both written and verbal, is critical for effectively educating providers and coders. Analytical and critical thinking skills are also needed to assess coding accuracy, identify areas for improvement, and trend analysis. PREFERRED and REQUIRED CERTIFICATION, EDUCATION, LICENSURE AND EXPERIENCE INCLUDES:

• Risk Adjustment Coding - Certified Risk Adjustment Coder (CRC) required and
• Auditing - Certified Auditor Certified Professional Medical Auditor (CPMA) required and
• Education – 5+ years’ provider auditing and clinical/education experience or teaching, training, educator/instructor background required.
• Documentation Improvement - Certified Documentation Expert Outpatient (CDEO) or Certified Clinical Documentation Specialist-Outpatient (CCDS-O) preferred.

EXCELLUS CONTRACT SPECIFIC Risk Adjustment Coding, Auditing and Education primary functions:

• Working and managing a specific patient population of approx. 500 Excellus patients with the top 5 chronic conditions being required to be assessed and validated on an encounter, with notation of any invalid diagnoses.
• RA Coding Auditor Educator will be the primary point of contact for Excellus contracted chronic condition validation.
• Review of the patient population with chronic and/or suspect condition(s) gaps and provide these gaps via OPA in the EHR to the PCP prior to their next visit.
• HCC education and training will be conducted per Excellus payer risk adjustment coding guidelines and required of all PCPs within the practices of SJH. Education will include one-to-one chart reviews of an individual PCP’s charts with specific recommendations and education plan(s).
• Reporting on a weekly basis back to Excellus and SJH team of work completed and unable to complete as well as any education provided.

MISSION STATEMENT: We are passionate healers dedicated to honoring the Sacred in our sisters and brothers. VISION: To be world-renowned for passionate patient care and outstanding clinical outcomes. CORE VALUES: In the spirit of good Stewardship, we heal by practicing: Compassion through our kindness, concern and genuine caring, Reverence in honoring the dignity of the human spirit, Excellence in expecting the best of ourselves and others; Integrity in being and speaking the truth. RELATIONSHIP-BASED CAREGUIDING PRINCIPLES: Caring and healing practices are found in relationships, communication and the hospital setting. Patients are actively involved in their care and experience a therapeutic relationship with the caregiver. Patient care is designed to meet patient and family needs while taking into account the unique needs of each patient. These values are consistent in practice and include patient advocacy, safety and education. Teamwork promotes clinical excellence and is rooted in effective communication, accountability and continuity of care and respect for co-workers. Caring leaders create an environment in which caring relationships happen. These leaders emerge from all levels of the network helping to create a shared vision reflecting the mission, vision, and values of St. Joseph’s. Note: Bargaining unit employees are governed by the terms and conditions of their respective collective bargaining agreements, which supersede the Employment-At-Will Statement. Pay Range: $28.55--$43.50 based on experience and location Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Apply Job! Apply to this Job