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AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Coding Educator is responsible for reviewing and providing education to providers across the AlohaCare network related to compliant documentation to support accurate Diagnosis and Evaluation & Management code assignment. The educator establishes relationships with key providers and staff, ensuring continued rapport that allows for enhanced partnerships. They monitor data and provide guidance regarding provider documentation and practice patterns to support compliance with federal guidelines and assure appropriate revenue cycle/reimbursement processes.
The educator collaborates with other quality managers and with managers and directors across the organization to increase the visibility and understanding of quality issues, including the impact of coding on quality scores and accuracy of risk adjustment score. The educator will work with the Director of Quality, The Quality Reporting Manager, finance staff, provider services staff and other managers and directors on the development and execution of coding projects and programs that drive organizational goals. They will help develop strategies and communications related to such projects and programs. They will work with the Director of Quality to advance partnerships with providers and community organizations that are aimed at improving quality performance via improved coding practices, and may interface with vendors and consultants to support aligned projects and programs on behalf of the organization.
Primary Duties & Responsibilities:
• Under the leadership of the manager, assists in the development and execution of a comprehensive coding education strategy for the organization in partnership with other quality leaders.
• Develops and maintains timelines and project management tools for the department.
• Develops communications, tools, educational materials and other work product related to proper coding for internal and external use as needed, often in collaboration with other leaders or departments.
• Maintains relationships with external partners to nurture relationships and gain valuable business insight, particularly around issues of proper coding.
• Remotely or in person, works alongside provider staff or independently as appropriate to assess current coding practices against EMR data and make recommendations for coding changes to provider/staff as appropriate.
• Assists provider services in developing quality and coding focused strategy and communications, and liaises with providers on issues related to AlohaCare’s quality programs as needed, in collaboration with appropriate provider services representatives and quality staff.
• Bachelor’s degree or equivalent experience.
• Minimum of five years of experience in medical coding and billing required.
• Must have successfully completed CPC or AHIMA certification
• Certified Risk Adjustment Coder certification within one year of hire required.
• Must maintain AAPC or AHIMA certification/membership.
• Experience in presenting coding education to providers
• Good written, verbal and electronic communications skills
• Good organizational skills and ability to work independently
• Possession of valid driver’s license with access to a reliable automobile.
• Previous training/education experience
• Knowledge of healthcare quality and HMO operations, HEDIS, STARS and value based programs.
• Knowledge of Hawaii Medicaid, Medicare
Physical Demands/Working Conditions:
• Inside working conditions
• No environmental hazards
• Ability to conduct training; potentially with audiovisual presentations
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.Position Description »