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Job Title:

Revenue Management Educator (Remote Option within SHP Service Area)

Cost Center:

682891390 SHP-Strategic Finance

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

JOB SUMMARY

The Security Health Plan Revenue Management Educator is accountable for the successful development, implementation and delivery of educational and training resource materials to assist providers in coding accuracy. The Educator develops and implements strategic action, quality improvement and risk management plans. The Educator provides overall educational support and coding quality assurance activities to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare Medicaid Services (CMS) and the Department of Health Services (DHS).

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: Bachelor’s degree with an emphasis in a business or medical field, or a registered nurse degree. Completion of courses in Current Procedural Terminology (CPT), and ICD‐9, ICD-10 and Hierarchical Condition Category (HCC) coding.

Preferred/Optional: Bachelor of Science in Nursing.

EXPERIENCE

Minimum Required: Three years’ experience in a health insurance, nursing,

compliance, or auditing related position. Knowledge of CPT coding rules, ICD‐9 and ICD‐10

codes, Healthcare Common Procedure Coding System (HCPCS) codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines. Demonstrated knowledge of anatomy/physiology, medical terminology, Word, Excel, Power Point and Access.

Preferred/Optional: Adult education/training and curriculum development.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: Certified Professional Coder certification awarded by American Academy of Professional Coders required within one year. State of Wisconsin Registered Nurse license (if applicable).

Preferred/Optional: Certified Risk Adjustment Coder awarded by American Academy of Professional Coders.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program .

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.