Job Description

Episource, with over 3500 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans. Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.

OVERVIEW: The Medicare Risk Adjustment Educator is responsible for identifying opportunities to improve provider documentation and creating a customized education plan tailored to each assigned provider. In this role, the Educator will integrate with the on-site staff to review medical records and arrange educational sessions with the provider aimed at quality of care and documentation improvements.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Review and analysis of provider documentation, with an eye toward compliance with CMS rules and regulations and capture of risk adjusting (HCC) diagnoses
• Devise a plan of education for each assigned provider to address discrepancies or inadequacies identified in documentation.
• Educate the provider in a face-to-face, one-on-one environment on an ongoing basis.
• Travel to offices to meet with providers
• Complete records/logs of provider education sessions and the topics discussed
• Work with provider offices to schedule appointments when the provider is available
• Build a long-term rapport with assigned offices/providers
• Additional duties as necessary to meet the obligations of our clients
• A valid driver’s license and insurance/liability policy in the employee’s name is mandatory in applicable cities/states when a motor vehicle is necessary for the position. Management will notify such employees when applicable.

QUALIFICATION REQUIREMENTS:

• Experienced medical coder with strong knowledge of Medicare Risk Adjustment (HCC) coding
• Possess CPC certification
• Strong communication skills; able to interact with physicians and other clinicians on a professional level
• In-depth knowledge of ICD-10-CM diagnostic coding in the Medicare Risk Adjustmentenvironment
• Four years minimum experience with HCC coding; 5+ years preferred
• Minimum 3 years of strong office/customer service administration experience required
• Familiarity with common electronic medical record applications such as Epic
• Basic understanding of project management methodologies and key terms
• Must have excellent time management skills, be highly organized, self-motivated
• Maintain a high level of productivity and confidentiality
• Excellent customer service, problem-solving skills, and attention to detail
• The ability to follow through timely on tasks is essential
• Possess excellent written, verbal, and interpersonal communication skills
• Team-oriented and leadership skills
• Must possess initiative; tact; poise; neat personal appearance; physical condition commensurate with the requirements of the position
• Some travel required. At times travel within a 30-50 mile radius is expected

EDUCATION:

• HS Diploma/GED required; preferred AA or higher degree or equivalent job related experience
• CPC Coding certification

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is frequently required to stand, walk, sit and lift. The employee must lift, carry and/or move medical records weighing up to 10 pounds. The Employee must have the ability to engage in repetitive motions such as utilizing a computer and reviewing medical records. Specific vision abilities required by this job include color vision. Requires prolonged sitting, some bending, stooping and stretching, requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports

Company Description

ABOUT US: SIMPLE, QUALITY, AND COST-EFFECTIVE SOLUTIONS TAILORED TO THE NEEDS OF OUR CLIENTS. Episource is driven to collect data that's insightful and accurate. With innovative technology and a global services model, we offer intuitive analytics to impact meaningful growth. From robust Risk Adjustment Analytics, Retrospective Chart Reviews, Quality Reporting, Encounter Data Submissions, and Clinical Services, Episource starts with the smallest of details and translates them to create better patient insights around disease profiles and care gaps. We know that behind each chart and every code is a real person. Humanity is our binding element, and we have your members in mind. Our vision is to provide health information exchange solutions that allow healthcare organizations to safely and efficiently manage member-centric data, quality of care initiatives, member intervention and management programs, risk adjustment programs in Medicare, Medicaid, Commercial, and Exchanges. Episource emphasizes driving value, operational excellence, respect, and integrity in all aspects of our operational and professional conduct, while striving to reflect the highest ethical standards in our relationships with members, providers, and our clients. Embracing a hybrid model that caters to the requirements of the global market, Episource concentrates application and functional expertise located both onshore and offshore, where we leverage best practices and economies of scale. Our highly-skilled workforce is trained in a consistent client delivery approach that emphasizes value, and enables clients to focus more on their core competencies.