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Role Description

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.

• 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.
• Ensures accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS).

Qualifications

• 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.
• Adult education/training and curriculum development (preferred).

Requirements

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

Benefits

• 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.