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    Coding Education Specialist - Philadelphia, United States - The Cigna Group

    The Cigna Group
    The Cigna Group Philadelphia, United States

    3 weeks ago

    Default job background
    OTHER
    Description
    The job profile for this position is Provider Data Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.

    Excited to grow your career?

    We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

    Our people make all the difference in our success.

    Job Description: Coding Education Specialist (AHIMA or AAPC certified) - Philadelphia, PA

    We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

    Our people make all the difference in our success.

    What you must have in order to do the job:

    • Remote, Work from Home – must be located in Philadelphia, PA – required to work in the field/visit multiple provider offices each week
    • Coding certification required (at least one of the below):

    Certified Professional Coder (CPC)

    Certified Risk Adjustment Coder (CRC)

    Certified Coding Specialist for Providers (CCS-P)

    Certified Coding Specialist for Hospitals (CCS-H)

    Registered Health Information Technician (RHIT)

    Registered Health Information Administrator (RHIA)

    • OR – RN/LVN/LPN licensure (must obtain one of the above coding certifications within one year of hire)
    • At least two years of hospital inpatient / outpatient or medical office coding experience, preferably two years risk adjustment coding experience.
    • Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines.
    • Excellent understanding of medical terminology, disease process and anatomy and physiology.
    • Working knowledge of CPT/Evaluation and Management guidelines
    • Working Knowledge of CMS Risk Adjustment and HCC Coding Process
    • Strong computer skills (i.e. MS Office)
    • Prior audit/quality experience.
    • Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers.
    • Minimal travel may be required for this position and person needs to be available for day, evening and weekend training sessions and meetings.

    Core Responsibilities:

    • Develop relationships with clinical providers and staff
    • Ability to communicate coding and documentation guidelines and education
    • Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
    • Customize presentations to educate providers and staff.
    • Understands, develops, tracks, monitors and reports on key program performance metrics for coding initiative
    • Conduct chart reviews for providers and review provider performance. This is accomplished by doing virtual training sessions or traveling to the individual practices and performing side-by-side education.
    • Work closely with internal representative for needs and support
    • Evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures
    • 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
    • Participate in monthly Quality reviews
    • Assist, as needed, 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
    • Perform the minimum number of coding quality reviews consistent with established departmental goals
    • Take direction and guidance from Coding Supervisor and Population Health leadership
    • Maintain a 95% 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, CPT, HCPCS
    • Capacity to attend provider meetings day/evening/weekends as needed within assigned areas
    • Work closely with matrix partners including Provider Engagement, Stars, Clinical and Population Health teams as well as vendors to ensure provider office communications are effective and efficient
    • Analyze data regarding trends or patterns identified in provider office diagnosis coding.
    • Track work, action plans, and progress in CRM tool
    • Assists with research, analysis and response to inquiries from all internal and external audit departments regarding compliance, coding and inappropriate coding
    • Leverage provided tool sets and reporting in day to day job role and educations
    • Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, HCPCS
    • Assure compliance by delivering quality services and meeting all contractual, state, and federal legal and regulatory requirements
    • Maintain CEU credits to ensure credentials are kept up to date.
    • Conduct preliminary audit review of Annual Wellness Visit forms and attestations on defined percentages by IPA or POD
    • Provide timely and appropriate feedback on Annual Wellness Visit forms and attestations to provider; maintain assigned portion of queue and ensure all transitions and hand-offs between coding and providers is covered

    If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

    Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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