Risk Adjustment Education Specialist - Health Plan Admin

Job Description

Summary:

This position will report to the Risk Adjustment Manager of Coding Operations. Responsibilities will include provider medical record audits, analysis of practice coding patterns, education, and training regarding risk adjustment. You will also analyze data to identify patterns and development of interventions at the provider level.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

• Subject matter experts for proper risk adjustment coding and CMS data validation.

• Work in conjunction with other departments, including Provider Relations, Quality, and the Medical Director, to ensure compliance with CMS risk adjustment guidelines.

• Analyze MRA data to identify patterns and development of provider and market-level interventions to coordinate an educational work plan for providers.

• Conduct provider education and training regarding risk adjustment to help ensure accurate CMS payment and improve care quality.

• This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.

• Responsible for building positive relationships with assigned Physicians and serving as a contact for any questions or concerns that may arise.

• Identify those Practices that need initial or ongoing additional training.

• Must be proficient in Prospective, Retrospective, and Concurrent review processes.

• This position does require the ability to have reliable transportation to conduct ongoing face-to-face interactions with Providers.

• Must have strong clinical knowledge of disease pathology and ability to identify clinical indicators related to chronic disease.

• Must be self-motivated: energetic, self-starter; can work autonomously with limited direction.

• Must be results-oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes.

• Must be analytical: vital research, writing, analytical, and critical reasoning skills.

• Must be a good communicator: conveys thoughts and expresses ideas concisely and effectively both verbally and in writing; strong presentation skills.

• Must be a good collaborator: orientation to team-based work product and results, open to change and process enhancement.

• Perform other duties as necessary.

Requirements:

Work Type:

Full Time

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Risk Adjustment Education Specialist - Health Plan Admin

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