Job Description

Position Description

The Provider Educator Specialist (PES) is responsible for providing expertise in the area of Risk Adjustment (RA) coding & Documentation for assigned provider groups. A Provider Educator Specialist will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. He/she will also coordinate implementation of programs designed to ensure all diagnoses are coded according to CMS and risk adjustment coding guidelines and conditions are properly supported by appropriate documentation in the patient chart. The Provider Educator Specialist will ensure that providers understand the STAR CPTII coding requirements.

Primary Responsibilities

* Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
* Educates and assists providers, virtually and in-person, in understanding the CMS-HC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding to ensure compliance with state and federal regulations
* Supports the providers by ensuring that documentation supports the submission of relevant ICD -10 codes and CPTII procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
* Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
* Reviews selected medical documentation to determine if assigned diagnosis, procedure codes and ICD-10 codes are appropriately assigned
* Refers inconsistent or incomplete patient treatment information / documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment
* Monitor and present coding initiative program performance with assigned health system/providers

REQUIRED QUALIFICATIONS

* High School Diploma or equivalent
* Certification from either American Medical Information management associated (AHIMA) or American Academy of Professional Coders (AAPC) is required (Clinical Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA)
* Ability to travel locally within territory 25-50% of the time to assigned health system/providers

PREFERRED QUALIFICATIONS

* Bachelors degree in core sciences or allied medical sciences
* Prior experience training professional adult learners in a medical setting
* Medical coding experience at either an inpatient or outpatient medical setting
* Extensive knowledge base on ICD-10-CM guidelines and its demonstration on medical code selection & sequencing
* Well versed on medical terminologies, etiology of disease and anatomy/physiology
* Working knowledge of Evaluation and Management (E&M) guidelines, billing & CMS HCC methodology
* Understanding of HIPAA laws and privacy policies in a care setting

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, youll enjoy meaningful career experiences that enrich peoples lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search TeamCigna on Instagram.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.