Introduction

Do you have the career opportunities you want as a Coding Education Specialist (Quality Improvement/Medicare Risk Adjustment) with your current employer? We have an exciting opportunity for you to join MountainStar Healthcare which is part of the nation's leading provider of healthcare services, HCA Healthcare. This position sits in Salt Lake City, Utah.

Benefits

MountainStar Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  
• Fertility and family building benefits through Progyny
  
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• Family support, including adoption assistance, child and elder care resources and consumer discounts
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan
  
• Retirement readiness and rollover services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Coding Education Specialist where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

The role of the Coding Education Specialist (Quality Improvement/Medicare Risk Adjustment) is to monitor and audit medical record documentation, coding and quality measures in the primary care practice offices participating in the Mountain Division HCA ACO and Clinically Integrated Network: MountainStar Care Partners. It is crucial for the Coding Education Specialist to have knowledge of HEDIS, CMS Hierarchical Condition Category (“HCC”) coding and billing guidelines, clinical standards, outcomes management skills, and the ability to set up practice and network level education programs around these topics.

The personnel in this position uses their knowledge of HCC coding, ICD-9/ICD-10, CPT, and documentation guidelines, along with clinical skills and practice management knowledge to assist in any and all coding and documentation audits and/or billing functions as determined by the CMO, Data & Analytics, and/or Quality department(s) while ensuring that all quality measures are completed annually for the patient populations for both the ACO and CIN.

In this role you will:

• Perform analysis on practice risk coding based on information from health plan partners, and create a stratified plan to work with practices that have most opportunity or impact on the Network.
• Work in tandem with health plan partner’s MRA Specialists to accumulate health plan specific documentation requirements, education materials, and training techniques.
• Accompany health plan MRA Specialists to practices for chart retrieval, chart audit, and education opportunities- or conduct practice site reviews independently.
• Perform all audits of documentation, coding and billing practices, in CCP primary care practices, specific to risk coding.
• Follow most current documentation and coding guidelines.
• Use only pre-approved source documents as validation for recommendations.
• Query providers on specificity of coding whenever there is question on specificity level.
• Create Education Series that will train practice providers, billing, and support staff, as well as MountainStar Care Partners staff, for Medical Risk Adjustment/HCC coding opportunities.
• Ensure that codes assigned meet medical necessity requirements by Medicare and other carriers.
• Create and assist with the maintenance of Chronic Condition Lists for all PCP practices.
• Assist in working with the missing condition reports from all carriers.
• Assist with all Scorecard initiatives – working with the PCP offices in capturing the coding data to support the performance on Scorecard metrics.
• Maintain database with the results of all medical chart reviews performed, with ability to report on statistics and practice progress on coding initiatives.
• Assist in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary.
• Report any issues to supervisor, the Network CMO, and the Data and Quality Teams as necessary.
• Serve as the MountainStar Care Partners staff educator and expert on Medical Risk Adjustment coding.

Education:

• High school diploma or equivalent
• Minimum of 2 years coding experience
• Experience with HCC coding and the MRA reimbursement structure is required
• The American Academy of professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification preferred; CPC will be considered with MRA experience
• Clinical background preferred

Knowledge/Skills/Abilities:

• Strong knowledge of CMS coding guidelines
• Knowledge of several EHR systems; preferably Athena, eCW, EPIC, etc.
• Exceptional interpersonal, public speaking, and presentation skills. Clear and confident communicator internally and with members/external partners
• Intermediate knowledge of Microsoft Office applications, including Word, Excel and PowerPoint
• Adaptability – Maintaining effectiveness when experiencing major changes in work tasks or the work environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
• Managing Conflict – Dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
• Ability to work independently; resourceful and proactive
• Passionate about improving the healthcare system
• Ability to travel within Mountain Division (Utah, Idaho and Alaska)

This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).

HCA’s Mountain Division offers careers within 11 respected and integrated hospitals within Utah, Idaho and Alaska. While each site is unique in location, size, and community, all Mountain Division facilities share commonalities of compassion, patient-focused, quality care and collaborative teamwork. We know that together, we’re greater. We know that what makes us better makes our patients better. That’s why our facilities consistently receive national recognition for top quality and exceptional safety.

HCA’s Mountain Division hospitals are part of HCA Healthcare - a network of more than 300 affiliate hospitals, outpatient centers and business offices across the country – offering employees the opportunity for travel and relocation. HCA facilities are all about caring for people, and that care extends to patients, families and employees.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Coding Education Specialist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.