Job Description

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Current employees can apply directly through the Internal Careers Center online for Prospect Medical job openings in California. For a streamlined application process, all you need is your four-digit employee ID number and a digital copy of your résumé handy before you apply.

Provider Coding Educator

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position is responsible for supporting and tracking RAF/HCC and coding education for clinical providers.

Job Responsibilities/Duties

• Support the Clinical Operations in the items that follow:
• Identify and Target local providers who would benefit from medical risk adjustment training
• Educating providers on how to improve their RAF scores, which measure their patient's health status
• Develop customized provider-specific plans to improve RAF performance
• Training providers on RAF methods and tools and working toward compliance
• Collaborate with providers and clinic office support staff and our internal personnel and external vendors on a wide scope of RAF efforts.
• Conduct provider chart reviews as needed to aid in provider education
• Identify potential suspect diagnoses that may be used to further provider education
• Rely on independent judgment and decision making, while at the provider site relevant to chart reviews, education based on historical or real time data
• Able to field any questions or concerns and provide solution that will mirror management guidelines.
• Implement education and provide format training to providers and staff as needed regarding coding compliance, documentation guidelines, HCC education and Medicare/Medicaid regulations.
• Utilize management for escalation purposes
• Work independently and rely on professional discretion and judgment.
• Maintain strictest confidentiality based on HIPPA policies
• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations
• Provide feedback and present solutions to the Medical Director of Performance Programs for general and individual provider education
• Schedule provider education sessions independently or in collaboration with Network Management.
• Performs related and work projects as required.
• Develop and maintain provider education tracking and educational materials.
• Able to work with others white competing multiple tasks simultaneously and successfully.
• Maintain a professional image and attitude
• Able to prioritize and organize multiple tasks
• Ability to make decisions in the absence of detailed instructions and work independently or in a team environment
• Ability to multi-task, prioritizes, and works in a fast- paced environment.
• Local travel is expected.

Qualifications

Minimum Education: Any combination of education and experience, which would provide an equivalent background in the description that follows. Requires BA/BS in health sciences, computer science, or nursing bachelor’s degree preferred in Business, Computer Science, Healthcare or related field.

Minimum Experience: Three (3) years of experience in healthcare including provider relationship management, ICD-9/1CD-10 coding. Experience in a clinical setting is preferred. Excellent written and verbal communication skills required. Displaying professionalism while representing the company. Experience working with MS Office (Proficient level with PowerPoint, Excel and Word / Familiarity with Access) required. Must have intermediate reasoning and problem-solving abilities and planning skills. Ability to interpret a variety of instructions furnished in written, oral, diagram, and schedule form. Ability to speak, read, and write English proficiently. Demonstrate exceptional verbal/written/communication skills.

Req. Certification/Licensure: CPC, CCS, CCS-P, or other recognized coding certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Educator, RAF/HCC, Clinical Operations, ICD9, ICD10, MS Office, CPC, CCS, CCS-P.