This position is partially work from home in Denver, CO.
Summary: Responsible for educating
and advising providers and practice staff in Medicare coding guidelines,
focusing on revenue enhancement opportunities. Work in collaboration with other
PHP departments and Optum/United HealthCare Medicare Advantage(MA) or other health
plans to develop plans and materials that support education and system changes
to meet practice and IPA revenue goals.
Communicates well both verbally and in
writing, creates accurate and punctual reports, delivers presentations, shares
information and ideas with others, has good listening skills.
Collaborates to develop plans and present to
practices the HCC education program that reflects IPA ethical standards and
Collaborate with Optum and PHP data analysts
to develop meaningful practice-level reporting to assist in coding and code
submission more effectively.
Work with contracted Medicare Advantage plans,
Optum and other third party vendors to drive or supplement educational forums
B. PROBLEM SOLVING
Breaks down problems into smaller components,
understands underlying issues, can simplify and process complex issues,
understands the difference between critical details and unimportant facts.
Identify potential data flow obstacles within
assigned practices and work with practice staff to develop action plans to
assist practices in overcoming obstacles.
Involve PHP Practice Transformation Coach to assist practices as
Identify and solve issues with other vendors
(billing companies, clearinghouse, etc.) to remove obstacles that prevent
maximum code extraction and submission.
fair workload, volunteers for additional work, prioritizes tasks, develops good
work procedures, manages time well, handles information flow.
Risk adjustment chart reviews.
Educate physicians and office staff on coding
techniques to accurately document and capture patient acuity to the highest
degree of specificity while maintaining Medicare guidelines.
D. SELF DEVELOPMENT
Seeks out and accepts feedback, is a proactive
learner, takes on tough assignments to improve skills, keeps knowledge and
skills up-to-date, turns mistakes into learning opportunities.
Maintains working knowledge of changing health
industry environment related to the risk adjustment model and CMS expectations
such as tolerance, fraud/abuse responses, etc.
Remain current on CEUs to maintain CPC and
other professional cerifications.
E. CUSTOMER FOCUS
Builds customer confidence, is committed to
increasing customer satisfaction, sets achievable customer expectations,
assumes responsibility for solving customer problems, ensures commitments to
customers are met, solicits opinions and ideas from customers, responds to
Be a primary resource for physicians and
office staff to answer questions or access resources to support documentation
and coding for risk adjustment.
Interface with assigned practices on a regular
basis to help develop and maintain engagement levels of practices.
Build relationships with practices to help
them understand the importance of documentation and coding in a manner that addresses
overall patient care management and IPA revenue goals.
F. JOB KNOWLEDGE
Understands duties and responsibilities, has
necessary job knowledge, has necessary technical skills, understands company
mission/values, keeps job knowledge current, is in command of critical issues.
Other duties as assigned.
- Associates or Bachelors’ degree required.
- Certified Professional Coder (CPC) required.
- Certified Risk Adjustment Coder (CRC) required
or commitment to get within 1 year of employment.
- Minimum two years’ experience in a medical
office and/or working with medical records, preferably electronic medical
- CPMA or additional certification preferred.
- Knowledge of health care insurance claims
practice and compliance.
- Knowledge of Medicare rules and guidelines.
- Knowledge of Claims Coding (CPT, HCPCs,
Revenue Codes, ICD-9/ICD-10, UB92, HCFA 1500).
- Knowledge of risk adjustment categories and
- Knowledge of MS Office Suite, Electronic
Medical Records, Encoder, Coding Clinic, other software programs and internet
based applications as needed to fulfill position duties.
- Skilled in synthesizing data and questions to communicate
a cohesive educational training program.
- Skilled in responding to practice inquiries in
a timely and accurate manner.
- Skilled in working collaboratively with
various parties to communicate an accurate and meaningful reporting package for
- Able to work effectively with physicians, practice
staff, health plan/other external parties and PHP multidisciplinary team to
streamline efforts to meet HCC Coding goals.
- Able to work with sensitive data and relay
potential issues or concerns in a diplomatic manner.
- Able to multi-task and meet deadlines.
- Able to work with external parties to obtain
resources as needed.
- Able to communicate findings in a clear,
concise manner, both internally and externally, including presentations.
- Required Licensure or Certification for this
position must be maintained by the employee as defined by the company policies
- A valid unrestricted Colorado drivers’
- Reliable and insured vehicle.
- Home office that is HIPAA compliant for all
remote or telecommuting positions as outlined by the company policies and
- Mobile Device for work purposes as defined by
the company policies and procedures.
Demands The physical demands described here are representative of those
that must be met by an employee to successfully perform the essential functions
of this job. Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions. While performing the
duties of this Job, the employee is regularly required to sit; use hands to finger,
handle, or feel and talk or hear. The employee is frequently required to
stand; walk; reach with hands and arms and stoop, kneel, crouch, or
crawl. The employee is occasionally required to climb or balance. The
employee must regularly lift and/or move up to 25 pounds. Specific vision
abilities required by this job include close vision and ability to adjust
Work Environment The work environment characteristics
described here are representative of those an employee encounters while
performing the essential functions of this job. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential
functions. The noise level in the work environment is usually moderate.