Revenue Management Educator (Remote Option within SHP Service Area)

Marshfield Clinic Health System • Marshfield, WI

3d • Remote

About The Position

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).

Requirements

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

Nice To Haves

• Bachelor of Science in Nursing.
• Adult education/training and curriculum development.
• Certified Risk Adjustment Coder awarded by American Academy of Professional Coders.

Responsibilities

• Development, implementation and delivery of educational and training resource materials to assist providers in coding accuracy.
• Develops and implements strategic action, quality improvement and risk management plans.
• Provides overall educational support and coding quality assurance activities to both internal and external stakeholders.
• Ensuring the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS).

Benefits

• Positions listed as 30 hours per week or greater are offered the level 1 benefit package. Positions listed as 20 – 29 hours per week are offered the level 2 benefit package. Positions listed as less than 19 hours per week are non-benefited.
• Benefits for temporary positions vary. Details will be discussed in the interview process.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level