Risk Adjustment Education Specialist - Risk Adjustment, Southwestern Health Resources, SWHR at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Risk Adjustment Education Specialist

Risk Adjustment Department

Southwestern Health Resources, a national leader in population health, is looking for a qualified Risk Adjustment Education Specialist to join our Risk Adjustment team.

If you're looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.

Position Highlights

Work location: Southwestern Health Resources Headquarters (SWHR), 1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234

Work environment: Risk Adjustment Department

Work hours:

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

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health Resources and University of Texas Southwestern Medical Center, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas.

The SWHR Network includes physicians from University of Texas Southwestern Medical Center and Texas Health Resources, as well as more than 2500 independent community Primary and Specialty Care Physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, across 16 counties in North Texas, resulting in lower costs and high-quality care.

In 2020, the Centers for Medicare & Medicaid Services (CMS) released the annual financial and quality results. Based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations (ACO), having saved nearly $120 million since joining the program in 2017.

SWHR is the parent organization of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.

Education

• High School diploma or equivalent is required.
• Associates degree or 2 years of additional experience is required.
• Bachelor's degree or 4 years of additional experience is required.

Experience

• 2 years of HCC coding with bachelor's degree or 4 years HCC coding with associate degree or 6 years of HCC coding with a H.S. diploma or equivalent is required.

Licenses and Certifications

• CPC - Certified Professional Coder is required upon hire.
• CRC - Certified Risk Coder is preferred.

Skills & Abilities

• Ability to communicate and interact positively and professionally throughout all levels of the organization and with external customers.
• Strong organizational skills in multiple settings, as well as the ability to exercise sound judgment and initiative. Strong presentation skills.
• Excellent problem solving and the ability to handle multiple projects, heavy workloads and deadlines in a fast-paced dynamic environment.
• Self-motivated with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member.
• Strong working knowledge of MS Office products, including PowerPoint, Excel, and Word; Adobe Captivate, Articulate and/or MLS relational database knowledge desired.
• Ability to think strategically to develop new initiatives/processes that will achieve our specified targets. Provide clear, appropriate, and timely communication to promote a team environment throughout the department.
• Ability to motivate team and hold team accountable for the results. Ability to work effectively as an interdisciplinary team as well as independent.
• Excellent knowledge of file transfer and audit processes as they relate to Risk Adjustment and Quality.

Position Responsibilities

The Risk Adjustment Education Specialist assists in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects. Identifies opportunities to improve accuracy and completeness for revenue impact. Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives. Meet with RAF leadership to partner on Physician Risk Education strategy. Assist with the development and utilization of training and attendee tracking metrics and methodologies. Assist with the development of physician and staff coding remediation plans. Monitor education programs, timelines, learner progress and report to leadership when appropriate. Provides onsite instruction per location (practice/clinic) for physician practice and office staff with ICD-10-CM coding training focusing on Medicare Risk Adjustment documentation and coding opportunities. Provides instructional review of ICD-10-CM translations specific to Medicare Risk Adjustment-type diagnosis codes. Performs education and chart review on all RAF initiatives. Speak and present at outreach events and functions.

Why Southwestern Health Resources
As a Southwestern Health Resources employee, you'll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients' quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org

Apply Now