Company Statement
Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.
Risk Adjustment Coder & Provider Educator
🔍 New York, New York
Summary of Job
Collaborate with the Manager of Risk Adjustment Coding to identify OIG-related topics, then create effective and engaging provider webinars, and specific provider group training sessions. To support the HCC Data Confirmation programs review supplied medical records to determine if diagnosis codes mapping to HCCs meet government (CMS, HHS, State) documentation guidelines. Support the Manager of Risk Adjustment Coding on Vendor by executing quality coding validations to ensure vendors coding accuracy is meeting established service level agreements (SLAs). Identify areas for improvement for the execution of HCC Data Confirmation programs, and enhancing provider education materials to reflect changes in high risk diagnosis codes per regulatory bodies
Responsibilities:
- Ensure all coding practices follow legal requirements and review medical records to confirm submitted diagnosis codes satisfy M.E.A.T./T.A.M.P.E.R. criteria.
- Work closely with the Manager of Risk Adjustment Coding and external vendors to review, assess, and correct diagnosis codes for submissions, ensuring accuracy.
- Collaborate with leadership to bring Vendor work in-house, address coding updates, and support the HCC Data Risk Adjustment Confirmation Program.
- Help to identify diagnosis trends that can improve provider education and strengthen risk adjustment coding.
- Regularly meet with leadership to discuss coding findings and ways for improvement.
- Notify the Manager of Risk Adjustment Coding when corrective action is needed to maintain coding accuracy and compliance. Maintain a 95% or better coding accuracy through routine performance reviews.
- Collaborate with the Manager of Risk Adjustment Coding to identify key topics related to OIG compliance, risk adjustment, and documentation best practices.
- Create and present engaging provider education materials (e.g., PowerPoints, recorded webinars, webinar-associated quiz with rationales, etc.).
- Ensure that all educational content aligns with regulatory requirements and industry best practices.
- Maintain industry coding knowledge, certifications, and coding compliance expertise.
- Assist in other initiatives and projects as needed.
Qualifications:
- Bachelor’s degree in healthcare or a related field
- CPC and CRC certifications required
- CDIP or CCDS certifications preferred
- 3 – 5+ years of experience in medical coding with a particular focus in risk adjustment (Required)
- 2+ years’ experience in provider education (Required)
- Additional experience/specialisted training/certification(s) may be considered in lieu of BS/BA degree (Required)
- Experience with CMS-HCC, HHS (ACA), and Medicaid models (Required)
- Working knowledge of medical terminology and anatomy/physiology (Required)
- Ability to manage time and work efficiently to meet deadlines with minimal supervision (Required)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all levels/types of audiences (Required)
- Ability to comprehend and deliver complex information effectively and efficiently (Required)
- Strong decision-making and problem-solving capabilities (Required)
- Capacity to multi-task at high detail-oriented level (Required)
- Strong working knowledge of MS Office (Word, Excel, PowerPoint, Teams, Access, etc.) (Required)
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.