Revenue Management Educator - Health Plan

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Work Shift: Day (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary Range: $26.00 - $41.50 Union Position: No Department Details Summary The Revenue Management Educator is accountable for the successful development, implementation and delivery of educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action, quality improvement and risk management plans. The Educator provides overall educational support and coding quality assurance activities to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Job Description Develops educational materials for providers in relation to diagnostic coding and risk adjustment revenue management to educate providers on thorough documentation and accurate coding. Identifies inadequate or erroneous documentation and/or coding to determine process improvement and educational opportunities. Research's appropriate material (terminology, testing, abbreviations) to accurately assess documentation. Analyzes coding and documentation to make appropriate judgments based on coding/ guidelines and policies. Monitors and audit performance in areas of compliance risk ensuring that established policies and procedures are being followed. Identifies the root cause of any errors to determine process improvement opportunities that may result in training, reference material revisions, and process changes. Assists in audits as it related to risk adjustment revenue management to address clinical issues related to documentation and coding. Assesses health insurance products, compliance, or operational risks and develop risk management strategies to improve revenue and reduce audit risk. Reviews, interprets and disseminates information relating to pending industry changes, trends and best practices to include CMS and DHS guidelines related to revenue management to anticipate necessary audits and education for providers. Qualifications Bachelor’s degree required with an emphasis in a business or medical field, or a registered nurse degree. Completion of courses in Current Procedural Terminology (CPT), and ICD‐9, ICD-10 and Hierarchical Condition Category (HCC) coding required Will consider years of experience in lieu of bachelor's degree. Three years’ experience required in a health insurance, nursing, compliance, or auditing related position. Knowledge of CPT coding rules, ICD‐9 and ICD‐10 codes, Healthcare Common Procedure Coding System (HCPCS) codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines. Demonstrated knowledge of anatomy/physiology, medical terminology, Word, Excel, Power Point and Access. Adult education/training and curriculum development preferred. Certified Professional Coder certification awarded by American Academy of Professional Coders required within one year required. State of Wisconsin Registered Nurse license (if applicable). Certified Risk Adjustment Coder awarded by American Academy of Professional Coders preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to .