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Medical Coding/Risk Adjustment Educator Job in denver, AA

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Job Title: Medical Coding/Risk Adjustment Educator

Employer:Physician Health Partners
Job Location:Partial Remote
Skills:Claims coding,Medicare knowledge,medical records,risk adjustment education
Required Certifications:CPC
Preferred Certifications:CRC (obtain within 1 year of employment)
Required Experience:1 to 2 years
Preferred Experience:3 to 4 years
Location:1125 17th st, ste 1000 denver 80202, AA, US
Date Posted:9/2/2021

This position is partially work from home in Denver, CO.

Position 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.


COMPETENCIES/Role-Specific Functions: 



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 Medicare guidelines. 

·         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 and reports.



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 needed. 

·         Identify and solve issues with other vendors (billing companies, clearinghouse, etc.) to remove obstacles that prevent maximum code extraction and submission.



Manages a 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.



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.



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 customers.

·         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. 



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.


Qualifications (Education/Experience/Knowledge/Skills/Abilities): 

  •  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 records.
  • 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 hierarchy preferred.
  • 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 practices.
  • 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 and procedures.
  • A valid unrestricted Colorado drivers’ license. 
  • Reliable and insured vehicle.
  • Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures. 
  • Mobile Device for work purposes as defined by the company policies and procedures.

Physical 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 focus.

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.



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