Risk Adjustment Education Specialist - Southwestern Health Resources (SWHR)

Work location: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: Risk Adjustment Department.

Please note: The Risk Adjustment Education Specialist will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).

Work hours:

· Full-time, 40 hours per week, Monday - Friday, Day shift.

· This is a Hybrid position, to be based in North Texas/Dallas-Fort Worth area.

· In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.

Organization Highlights

Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 29 hospital locations and more than 6,900 physicians and clinicians caring for more than 730,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan providing care to over 12,000 members.

At SWHR, we believe healthcare can be more integrated, accessible and affordable for all. Our purpose: to build a better way to care, together. Our promise: to simplify and empower care, for good.

Education

• High School Diploma or equivalent required.
• Associates Degree preferred.

Experience

• Require 3 years of Risk Adjustment Coding and Auditing or related experience.
• Highly prefer 1 year of Prior Coding Education and Training experience.

Licenses and Certifications

• Require a current professional coder certification (RHIT, RHIA, CAC, CPC, CPC-A, COC, CPC-P, CCS) with credentialing from AHIMA and/or AAPC and must be maintained annually,

OR,

• Require Certified Risk Coder (CRC) Certification.

Skills & Abilities

Strong knowledge of Microsoft Office products (Word, Excel, PowerPoint, etc.)

Excellent analytical, organizational, and time management skills with the added ability to present information in front of groups of people.

Thorough knowledge of CMS Medicare Advantage documentation and submission policies and ICD-10-CM coding guidelines.

Ability to manage multiple tasks and projects and forge strong working relationships.

Ability to communicate clearly and effectively, both orally and in writing.

Position Responsibilities

The Risk Adjustment Education Specialist is responsible for providing Risk Adjustment education and chart reviews for the SWHR Provider Network. This role will work directly with Providers to assist in achieving accurate and complete coding documentation and improving metrics.

Position Functions

· Responsible for providing Risk Adjustment education, chart review, and training to assigned practices must be willing to travel onsite. Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data.

· Responsible for the collection and analysis of qualitative and quantitative data as it relates to Risk Adjustment specifically around prevalence and suspects.

· Contributes to the design and development of ad hoc reports and presentations for Risk Adjustment initiatives.

· Acts as Risk Adjustment documentation and coding expert, monitoring and answering questions for assigned clinics. Provides an instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment coding. Responsible for identifying and influencing adoption of resources and processes to reach risk adjustment and quality goals of assigned.

· Develop and maintain strong working relationships with assigned SWHR clinic partners, including providers and support staff.

· Develops physician and staff remediation plans.

· Conduct audits on vendor coding platforms.

· Responsible for tracking, scheduling, and coordinating all education services, including onboarding activities for Risk Adjustment coding and documentation. Monitor education programs, timelines, and learner progress and report to leadership when appropriate.

· Meet with RAF leadership to partner on the Physician Risk Education Strategy.

· Speak and present at outreach events.

· Other duties as assigned.

#IndeedLB

Job Type: Full-time

Pay: $31.50 - $49.50 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

COVID-19 considerations:
Please follow SWHR Employee Health Services guidelines.

Education:

• High school or equivalent (Required)

Experience:

• Risk Adjustment Coding and Auditing or related: 3 years (Required)
• Coding Education and Training: 1 year (Preferred)

License/Certification:

• RHIT, RHIA, CAC, CPC, CPC-A, COC, CPC-P, CCS or CRC (Required)

Work Location: Hybrid remote in Farmers Branch, TX 75234

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