RAF/STARS
Coding Educator
Phoenix, AZ, United States

It’s Time For A Change…Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

  • Conduct chart reviews for providers and review provider performance. This is accomplished by traveling to the individual practices and performing side-by-side education
  • Develop relationships with clinical providers and communicate coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
  • Evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators.
  • Query providers regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
  • Analyze data to prioritize provider educational reviews. Implement education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards
  • Assist, as needed, with HCC coding to meet departmental goals/deadlines
  • Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data
  • Assists with research, analysis and response to inquiries regarding compliance, coding, and inappropriate coding
  • Compile data and present solutions regarding trends or patterns noticed in provider coding
  • Create Policy and Procedures to be used within the department to support Best Practices
  • Perform the minimum number of coding quality reviews consistent with established departmental goals
  • Take direction and guidance from Risk Adjustment Coding Lead and the General Manager of the Risk Adjustment Program
  • Maintain a 96% quality audit accuracy rate
  • Maintain strictest confidentiality based on HIPAA privacy policy
  • Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10-CM book, and other pertinent materials 


The Experience You Need (Required):

  • Undergraduate degree or equivalent experience
  • 3-5 years of ICD-10 coding assignments in a professional setting
  • Completion of coding certification course, AAPC/AHIMA and possess a CCS-P or similar certification
  • 2-4 years of experience with risk adjustment
  • A valid Driver’s license 


Finishing Touches (Preferred):

  • Ability to drive within assigned neighborhood
  • Knowledge of, and adherence to ICD-10/outpatient coding guidelines
  • Excellent understanding of medical terminology, disease process and anatomy and physiology 
  • Working knowledge of CMS Risk Adjustment and HCC Coding Process
  • Strong computer skills (i.e. MS Office)

 

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