Provider Education Specialist - Certified Coder Required
Cigna - Baltimore, MD

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Job Description

HealthSpring, a Cigna company, is one of the country's leading health plans focused on delivering care to the senior population, predominately through Medicare Advantage and other Medicare and Medicaid products. Along with its companies Bravo Health and Leon Medical Centers Health Plans, HealthSpring serves more than one million customers in locations across the country. Based in Nashville, Tennessee, HealthSpring operates health plans in Alabama, Delaware, Florida, Georgia, Illinois, Maryland, Mississippi, New Jersey, Pennsylvania, Tennessee, Texas, West Virginia and Washington, D.C. HealthSpring also offers a national stand-alone prescription drug plan. For more information, visit

Provider Education Specialist

The Provider Education Specialist is responsible for providing education and training to physician groups/offices on correct coding initiatives, , reporting on findings resulting from chart audits, ensuring accurate data entry for CMS submission, and providing education and training to physician groups/offices on correct coding initiatives.

This specialist ensures policies and procedures are monitored and updated to include regulatory changes and conducts training/education of physicians and/or physician offices through one-on-one and mass communications/presentations. The Provider Education Specialist must be available for day and evening off-site and telephonic training/education.. Requirements

Minimum Requirements:
At least two years’ of hospital inpatient / outpatient or medical office coding experience is required.

Some type of coding certification is also required and may include the following:

1 Certified Professional Coder (CPC),
2 Certified Coding Specialist for Providers (CCS-P),
3 Certified Coding Specialist for Hospitals (CCS-H),
4 Registered Health Information Technician (RHIT),
5 Registered Health Information Administrator (RHIA), or nursing medical background.

Additional responsibilities include:
Extensive knowledge of ICD-9-CM and/or CPT coding principles and guidelines (Diagnostic coding experience is highly preferred)

Familiarity with physician-specific regulations and polices related to documentation and coding.

Experience with Medicare Risk Adjustment guidelines.

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.

Microsoft Office expertise including Word, Excel and Power Point applications that will be used to develop and present training material

Preferred Requirements: Bachelor’s degree. Proficiency with DRG optimization. Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN), or Registered Nurse (RN).

Please Note: Travel will be required for this position and the viable candidate needs to be available for day and evening sessions.

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