Role Description

In addition to the responsibilities listed below, this position is also responsible for:

• Performing needs assessments to determine training needs and assisting team members to do the same.
• Implementing an appropriate curriculum to meet documentation and coding education program goals identified by needs assessment, supporting a high level of coding accuracy.
• Delivering training development, including dress rehearsals, the review process, curriculum testing, and final quality assurance of all training deliverables.
• Designing, developing, and implementing evaluation instruments to measure training outcomes.
• Guiding others in reviewing internal and external educational materials for content and appropriateness.
• Delivering follow-up trainings to maintain the level of competency earned from initial trainings.
• Driving the documentation of changes in laws, regulations, and coding and documentation standards as they apply to Coding Education.
• Creating and providing trainings in response to system upgrades or process changes.
• Providing subject matter expert guidance to market teams/groups in support of development, implementation, and monitoring practices for organizational goals and business objectives.
• Assisting with training and mentoring external vendors or contractors, as needed.

Qualifications

• Minimum three (3) years of experience developing educational materials and conducting training and education sessions in a multi-specialty setting.
• Minimum two (2) years of experience in International Classification of Diseases (ICD)-10-Clinical Modification, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding, including chart auditing, applying diagnoses and/or procedure coding, and/or conducting coding reviews.
• Associates degree in Health Information Management, Health Care Administration, or related field AND minimum five (5) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field OR Minimum six (6) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field.
• Registered Health Information Technician required at hire OR Certified Coding Specialist - Physician Based required at hire OR Certified Professional Coder required at hire OR Registered Health Information Administrator required at hire OR Certified Coding Specialist required at hire.

Requirements

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members.
• Builds relationships with cross-functional/external stakeholders and customers.
• Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers.
• Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses.
• Leads by influencing others through technical explanations and examples and provides options and recommendations.
• Adopts new responsibilities; adapts to and learns from change, challenges, and feedback.
• Demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes.
• Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions.
• Encourages team members to adapt to and follow all procedures and policies.
• Collaborates cross-functionally and/or externally to achieve effective business decisions.
• Provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate.
• Monitors progress and results.
• Supports the development of work plans to meet business priorities and deadlines.
• Identifies resources to accomplish priorities and deadlines.
• Identifies, speaks up, and capitalizes on improvement opportunities across teams.
• Uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Contributes to audit analysis and report writing by comparing coding and documentation across the enterprise to identify potential risks and remedies independently.
• Conducts trend analyses to identify patterns and variations in coding practices, key compliance drivers, liabilities, and performance indicators.
• Prepares written and/or generated audit reports using standardized language detailing all noted opportunities, and providing education as needed.
• Contributes to coding quality audits by conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope independently.
• Ensures compliance by following national, state, and KP-specific coding, billing, and documentation guidelines/guidance.
• Attends national committees and participates in National Compliance programs.
• Contributes to enhancing coding integrity by assisting with the identification of coding/documentation trends and opportunities.
• Leverages expert knowledge to aid teams in developing, implementing, and monitoring new processes and workflows.
• Leads the process of communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation to all impacted employees.

Benefits