Quality Coding and Documentation Educator I, Geisinger Health Plan
: Job Details :

Location:Work from home (Pennsylvania)Shift:Days (United States of America)Scheduled Weekly Hours:40Worker Type:RegularExemption Status:NoJob Summary:Provides training and process improvement efforts across the clinical practices for the development of consistent and comprehensive clinical practices supported by the the Health Plan. Identifies process improvement opportunities associated with the management of risk adjustment initiatives. Investigates current processes, assessing efficiency and accuracy and provides solutions for problems, process improvement, development of training programs, and documentation strategies that support ICD-10 complex terminology for clinical practice operations and management.Job Duties:

• Reviews the content of the medical record professional outpatient records to identify all diagnosis codes applicable to the documentation.
• Carefully reviews details of documents such as laboratory findings, radiology reports, various scanned reports, discharge summaries, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses are recorded.
• Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form correct procedure codes as required.
• Using the Encoder software program, determines the codes for all diagnoses Reviews and understands annual mapping of ICD-9 and ICD-10 crosswalk.
• Provides education material to the team to educate physicians as needed to clarify documentation within the patient's record to facilitate complete and accurate coding.
• Assists in decision making relevant to physician coding education and HCC targeting purposes.
• Works one-on-one with physicians as needed to clarify documentation within the patient's record as appropriate accurate and complete coding.
• Assumes a supporting co-educating role with regard to Risk Adjustment Education and other opportunities for internal education team and external identified opportunities.
• Presents with full understanding of reports, presentations, maps and graphs, reflecting the collaboration of external and internal parties, summary and translation of data into actionable information.
• Delivers presentations to clinicians and administrators.
• Shares condition-specific training modules as requested.
• Works with provider sites to define solutions to needs or problem areas, and determines scope of investigation required to obtain solution.
• Solutions may include installation of alternate methods and procedures, changes in methods and practices, or redesign of products or services.
• Interprets and recommends actionable plans using financial and analytical data prepared by risk adjustment analysts.
• Provides consultative support to clinical areas on a daily basis and recommends operational strategies to achieve optimal documentation and coding processes.
• Assists in proactive risk adjustment communication, support and education at all levels within the organization.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.Position Details:Coding/Billing Diploma PreferredInternet requirements:Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

• 25 MBPS UP
• 75 MBPS DOWN