Healthfirst

Position Summary: The Coding Educator is responsible for overseeing and educating providers on the proper use of diagnosis coding to ensure CMS and ICD10 CM guidelines are followed to substantiate the Risk Adjustment HCCs that are reported by providers. Responsible for auditing clinical documentation encounters to validate Risk Adjustment and HCCs Responsible for managing and responding to provider inquiries via the coding hotline as well.

• Trains clinical providers on coding guidelines, ensuring compliance around clinical documentation, coding guidelines. Using AMA Coding guidelines, CMS coding regulations, ICD10 coding rules and coding industry standards.
• Preparation and creation of PowerPoint presentations for department meetings.
• Creation of PDF Job Aid to describe coding rules for all specialties.  Responsible for CDI (Clinical Documentation Improvement) guidelines.

• Performs charge audits through review of chart notes and assigns correct procedure and diagnosis codes. 
• Review and analyze new ICD10 coding guidelines, new ICD10 changes and create education material every year around said changes
• Proficient on coding guidelines on all the specialties.
• Reviews audit results to identify and analyze trends, recommend and implement corrective actions.

• Regular site meetings with all our providers to provide coding and clinical documentation improvement to improve coding accuracy

• Manage and respond timely to provider inquiries via the coding hotline to ensure providers have the appropriate resources to handle coding questions.
• Consistently and accurately audits complex coding records for inpatient and outpatient – hospital and professional.
• Creates clear and concise audit reports. Reports non-compliance issues detected through auditing and monitoring.
• Establishes, implements, and maintains a formalized review process that incorporates regular audits (provider, coding and documentation adequacy) and coordinates ongoing monitoring with education to provider.
• Conducts trend analyses to identify patterns, variations in coding practices and case-mix index, including areas of risk and comparing coding profiles with national norms.
• Develops and coordinates educational and training programs regarding elements of the coding compliance program, such as appropriate documentation, accurate coding, data compatibility, consistency and monitoring for compliance to improve the quality of clinical data supported.
• Provides feedback and focused educational programs based on the results of auditing and monitoring activities to affected providers and hospitals
• Initiates corrective action plans and reports results of follow-up audits to Coding Manager and AVP.
• Maintains statistics on coding accuracy and provides monthly summaries of coding audit results
• Acts as a resource on coding issues and questions to ensure accurate coding for appropriate Risk Adjustment data capture for inpatient and outpatient.
• Demonstrates up-to-date knowledge of healthcare regulatory, coding mandates and OIG work plan.
• Analyze audits and RA findings.
• Maintains records of, files, education, presentations, etc. concerning all external physician audits.

• Minimum Requirements

  · Minimum five years’ experience coding education in a hospital, physician, or insurance environment

  · Minimum five years’ experience coding SOAP notes for different specialties

  · High School diploma or GED.

  · Certified Coding Profession certification: CPC and CRC (If no CRC, then it must be obtained within the first 6 months of employment)

  Preferred Requirements

  · Bachelor’s Degree Preferred

  · Certified Coding Profession certification: CPMA, CDEO, CCS, CCS-P, CDIP, RHIA, RHIT

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470

• All Other Locations (within approved locations): $71,600 - $106,505

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.