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Provider Education & Risk Adjustment Manager (FT Salaried) Job in Findlay, Ohio US
Monster
 
 
 
 

Job Summary

Company
Blanchard Valley Regional Health Center
Location
Findlay, OH
Industries
Government and Military
Job Type
Full Time
Employee

Provider Education & Risk Adjustment Manager (FT Salaried)

About the Job

PURPOSE OF THIS POSITION

The Provider Education and Risk Adjustment Manager serves in a lead role to support provider education and documentation initiatives to support value-based programs. This position develops and implements provider education programs and processes to support documentation best practices through compliant documentation, appropriate code selection and accurate capture of clinical complexity to support value-based care program. This position supports the oversight of risk adjustment initiatives (HCC, RAF scoring), collaborate with coding teams and providers to ensure accurate capture of chronic conditions and quality measures identifying trends and actions plans for continuous improvement to support value-based programs (CIN, ACO) initiatives. This position collaborates and serves as liaison between providers, ACO and internal teams, including quality, coding, IT, clinical department leadership and compliance, to align goals.

JOB DUTIES/RESPONSIBILITIES

Duty 1: Designs and implements education programs for physicians, APPs, and clinical staff to support documentation best practices, ICD-10 coding, HCC capture, RAF scoring, payer requirements and quality reporting.

Duty 2: Collaborates with clinical departments to develop prospective, concurrent and / or retrospective workflows and processes through documentation improvement initiatives (CDI) to support comprehensive and specific capture of conditions to support optimal reimbursement, value-based programs, and quality reporting metrics. Implements processes for annual condition recapture, suspect analytics validation, and closing documentation gaps for chronic conditions

Duty 3: Creates and implements new provider onboarding program, including audits performed at regular intervals to identify coding and documentation opportunities; provides feedback and education to provider based findings.

Duty 4: Provides department and one-on-one provider coaching based on data insights (e.g., chronic condition / HCC capture, suspected conditions, identified documentation gaps, etc.). Supports education through various provider friendly communication methods and tools, such as creation of presentations, reference guides, newsletters, key performance indicators, etc.

Duty 5: Collaborates with HIM coding leadership and coding auditor and educator to identify coding opportunities to support HCC capture / risk adjustment coding; works with coding leadership to identify and initiate coder training and education on needed.

Duty 6: Collaborates with IT, provider oracle training team and internal teams to evaluate system optimization opportunities and implementation of tools to support provider in documentation accuracy and efficiency (e.g. creation of templates, upfront tools to support provider code selection and specificity, processes to capture chronic conditions, etc.).

Duty 7: Serves as a liaison with the CICO to support compliance with value-based care models, representing coding & documentation practices on behalf of BVHS and to address coding & documentation opportunities identified associated with RAF score.

Duty 8: Establishes dashboards and KPIs for documentation accuracy, coding quality, RAF trends, condition recapture, and quality metrics

Duty 9: Ensures compliance with regulatory requirements, including CMS, OIG, payer contracts, AHIMA Standards of Coding Ethics, HIPAA and internal policies.

Duty 10: This job description reflects the general nature and expectations for the position. It is not an exhaustive list of activities, duties, or responsibilities involved. The incumbent may be asked to perform other related duties as needed.

Apply here: https://www.aplitrak.com/?adid=YmJnZW5lcmljLjU3OTcxLjEwNTA4QGJsYW5jaGFyZHZhbGxleWNvbXAuYXBsaXRyYWsuY29t
 
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