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Provider Education Specialist (AHIMA or AAPC certified) - Houston, TX (Remote, work from home), Houston, Texas

Created10/18/2020
Reference20015869
CategoryOperations
Job typeFull-Time
CountryUnited States
StateTexas
CityHouston
Zip77001
SalaryCompetitive
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  • We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!


Our people make all the difference in our success.

What you must have in order to do the job:
  • Remote, Work from Home - must be located in Houston, TX area
  • Coding certification required (at least one of the below):

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)
  • At least two years' of hospital inpatient / outpatient or medical office coding experience, preferably two years risk adjustment coding experience.


Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines. Excellent understanding of medical terminology, disease process and anatomy and physiology. Working knowledge of CPT/Evaluation and Management guidelines, Working Knowledge of CMS Risk Adjustment and HCC Coding Process, Strong computer skills (i.e. MS Office). Prior audit/quality experience. Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers. Minimal travel may be required for this position and person needs to be available for occasional day, evening and weekend training sessions.

Core Responsibilities:
  • Develop relationships with clinical providers/staff and communicate coding and documentation
  • Conduct provider training on health plan coding initiatives guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
  • Customize presentations to educate providers and staff Understands, develops, tracks, monitors and reports on key program performance metrics for coding initiative
  • Conduct chart reviews for providers and review provider performance. T his is accomplished by doing virtual training sessions (traveling to the individual practices and performing side-by-side education only as absolutely necessary).
  • Work closely with internal representative for needs and support
  • Evaluate documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures
  • Query providers regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
  • Analyze data to prioritize provider educational reviews. Implement education, where necessary, and provide formal training to providers and staff regarding coding and documentation standards
  • Participate in monthly Quality reviews
  • Assist, as needed, to meet departmental goals/deadlines Rely upon independent judgment and decision-making at provider sites, whether conducting chart review or providing training/education, both for historical and/or real time data
  • Assists with research, analysis and response to inquiries regarding compliance, coding, and inappropriate coding
  • Compile data and present solutions regarding trends or patterns noticed in provider coding
  • Perform the minimum number of coding quality reviews consistent with established departmental goals
  • Take direction and guidance from Risk Adjustment Coding Lead and the General Manager of the Coding Department
  • Maintain a 95% quality audit accuracy rate
  • Maintain strictest confidentiality based on HIPAA privacy policy Maintain current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM, CPT, HCPCS
  • Capacity to attend provider meetings day/evening/weekends as needed within assigned areas


Minimum Requirements:

- Coding certification through AHIMA or AAPC, which may include 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), required.

- At least two years' of hospital inpatient / outpatient or medical office coding experience, preferably two years risk adjustment coding experience required.
- Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines.

- Excellent understanding of medical terminology, disease process and anatomy and physiology.

- Working knowledge of CPT/Evaluation and Management guidelines, Working Knowledge of CMS Risk Adjustment and HCC Coding Process

- Strong computer skills (i.e. MS Word, Excel, PowerPoint).

- Prior audit/quality experience required.

- Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers.

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, you'll enjoy meaningful career experiences that enrich people's 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.
Employer835 CareAllies, Inc.

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