Under the direction of the Risk Adjustment Medical Director, this position is accountable for the education and support of Renown Medical Group (RMG) providers regarding the group performance of Medicare/ACA Risk Adjustment and quality programs. The position will provide on-site support and education to providers in order to increase performance based on data surrounding care gap closure, Risk Adjustment improvement initiatives and proper medical record documentation. The position will be responsible for developing and maintaining effective working relationships with providers, their office staff and internal stakeholders.
Nature and Scope
This position is responsible for improving Renown Medical Group provider performance as measured by an improvement in risk adjustment capture and a consequent increase in the Risk Adjustment Factor (RAF) Score. The role will require developing, implementing and maintaining initiatives through the education, support and outreach to RMG providers. The position will involve a significant amount of claim analysis, medical record review, CMS regulation research and IT specification review for accurately educating and supporting healthcare providers to optimize the performance on all performance initiatives. This position will also be expected to identify and enhance the quality of RMG provider medical record documentation opportunities and will be responsible for both face to face provider education and group meetings as appropriate. The position will utilize new technology, as appropriate, for efficient delivery of services and to make informed decisions based on data, to drive performance metrics across all group performance initiatives.
The essential functions of the position are:
· Educate RMG providers, office staff and internal stakeholders on all performance initiatives that support regulatory requirements for programs such as Medicare/ACA Risk Adjustment
· Educate and audit providers, office staff and internal stakeholders on medical record documentation and ICD-10 coding.
· Focus on closing care gap opportunities that support the group performance initiatives.
· Collaborate with providers to improve practice performance
· Select correct ICD code assignment by proficient analysis and translation of diagnostic statements, physicians’ orders, and other pertinent documentation.
· Maintain and grow the current knowledge of the Medicare and Commercial Risk Adjustment outpatient/inpatient billing systems/processes
· Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness
This position does not provide patient care.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Requirements - Required and/or Preferred
Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor of Science in Nursing, Public Health, Business, Health Care Administration or health-related discipline required.
Experience with Risk Adjustment is preferred. Experience working with Medicare program in a Health Plan setting is preferred. Minimum of three years’ of clinical experience required.
Current and unrestricted State of Nevada Registered Nurse license. Ability to obtain within 90 days a valid State of Nevada driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.
A current coding certification recognized by AAPC, AHIMA or other nationally recognized coding certification is preferred.
Computer / Typing:
Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also, must have a working knowledge of Microsoft Office products.