**Employment Type:** Full time **Shift:** Day Shift **Description:** **Risk Adjustment Auditor Educator** -St. Peter's Health Partners - Full-time - Remote **POSITION PURPOSE:** A Risk Adjustment Auditor Educator is responsible for ensuring accurate coding and documentation in alignment with risk adjustment models, conducting audits with analysis of trends, and providing education to providers and coders. They work to improve documentation quality, identify coding discrepancies, and ensure compliance with regulations as well as supporting SPHPMA, IHANY and Trinity Health’s risk adjustment and payer value-based plan initiatives to support revenue and compliance standards in our provider group. **SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:** Risk adjustment coding, provider auditing and clinical/education experience required. Must have 5 or more years’ experience as a risk adjustment auditor and educator and/or clinical documentation improvement specialist with a solid background in value-based plans (VBP), Medicare Advantage (MA) and Medicare shared savings program (MSSP) as well as a deep understanding of CMS guidelines, and other regulatory requirements are essential. Strong communication, both written and verbal, is critical for effectively educating providers and coders. Analytical and critical thinking skills are also needed to assess coding accuracy, identify areas for improvement, and trend analysis. **PREFERRED and REQUIRED CERTIFICATION, EDUCATION, LICENSURE AND EXPERIENCE INCLUDES:** + Risk Adjustment Coding - Certified Risk Adjustment Coder (CRC) required and + Auditing - Certified Auditor Certified Professional Medical Auditor (CPMA) required and + Education – 5+ years’ provider auditing and clinical/education experience or teaching, training, educator/instructor background. + Documentation Improvement - Certified Documentation Expert Outpatient (CDEO) or Certified Clinical Documentation Specialist-Outpatient (CCDS-O) preferred. **ESSENTIAL FUNCTIONS:** + Utilizes clinical, coding and auditing expertise to direct and fulfill efforts toward the improvement and integrity of clinical documentation through the role of auditor and educator to support the healthcare systems participation in the CMS risk adjustment model and value-based plans. + Facilitates the overall quality, accuracy and integrity of documentation through extensive record review, reporting, trending and education. + Serves as a resource for appropriate clinical documentation and improvement, HCCs, risk adjustment model and VBP parameters and guidance for providers, coders and other stakeholders. + Communicates with and educates providers and all other members of the healthcare team regarding clinical documentation and monitors provider engagement. + Identifies learning opportunities for healthcare providers and coders and reports to the Manager of Risk Adjustment Coding & Audit to develop and implement provider documentation improvement plans. + Conducts concurrent and retrospective audits of selected patient records to address quality and accuracy of documentation and corresponding ICD-10-CM choices to support proper payment in the risk adjustment model in which the healthcare system participates. + Formulates compliant queries following Trinity Health’s documentation integrity procedures. + Interacts with providers and clinical staff regarding compliant documentation requirements, query requests, and educational opportunities. + Participates in the curriculum development and delivery of education for providers and members of the healthcare team. + Performing quality audits and evaluating clinical documentation of provider charts + Obtain user and working knowledge of our retrospective, concurrent and prospective reviews workflows/processes by means of working in TogetherCare charge review WQs to support risk adjustment work for our populations. + Collaborates with coding staff to ensure documentation of diagnoses and co-morbidities is a complete reflection of the patient’s clinical status and care. + Collects and analyzes data to formulate recommendations and solutions based on audit trends and results. + Provides regular feedback to leadership on performance improvement opportunities as a result of performance gaps. + Resolves all discrepancies in a courteous manner and reports to all business partners involved. + Demonstrates expertise in problem-solving skills based on theoretical knowledge, clinical experience and sound judgement and serves as a professional role model by demonstrating desirable practice behaviors. + Develops and provides actionable quality audits related to the risk adjustment coding specialist team’s accuracy rates and trends. + Extensive working knowledge of Microsoft Excel to develop and provide comprehensive audit results and trends. + Maintains a working knowledge of applicable Federal, State and local laws and regulations, accrediting agencies, Trinity Health’s Organizational Integrity Program, Standards of Conduct, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. + Performs other duties as assigned by the leadership to support risk adjustment + Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, standards, policies, procedures and decisions. **CORE VALUES:** + **Reverence: We** honor the sacredness and dignity of every person. + **Commitment to Those who are Poor:** We stand with and serve those who are poor, especially those who are most vulnerable. + **Justice:** We foster the right relationships to promote the common good, including sustainability of Earth. + **Stewardship: We** honor our heritage and hold ourselves accountable for the human, financial, and natural resources entrusted to our care. + **Integrity** We are faithful to those we say we are. + **Safety:** We embrace a culture that prevents harm and nurtures a healing, safe environment for all. **PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS:** + Must be able to set and organize one's own work priorities and adapt to them as they change frequently. + Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. + Must possess the ability to comply with Trinity Health policies and procedures. + Must be able to spend the majority of work time utilizing a computer, monitor and keyboard. + Must be able to work with interruptions and perform detailed tasks. + Ability to concentrate and read for long periods of time. + Ability to work in a virtual environment. + If applicable, involves a wide array of physical activities, primarily walking, standing, balancing, sitting, squatting, and reading. Must be able to sit for long periods of time. + 100% remote, if local may include some travel to sites when necessary. + If applicable, telecommuting (working remotely), must be able to comply with Trinity Health’s and the Region/RHM Working Remote Policy. _The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned._ Pay range: $28.55-$41.40 Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location **Our Commitment** Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. EOE including disability/veteran