Risk Adjustment Provider Engagement Lead

📋 Description

• Verifies the accuracy of provider documentation by reviewing and analyzing samples of coding and claims extracts against actual medical records.

• Creates educational materials to aid physicians in accurately evaluating patients’ overall health status.

• Offers feedback to providers regarding performance improvement opportunities; organizes and prioritizes projects aimed at enhancing coding and documentation outcomes.

• Maintains a detailed tracking and management tool for assigned physicians within the Alignments Healthcare provider network.

• Identifies potential issues, assesses their impact on risk adjustment models, and promptly reports findings to ensure compliance for physicians.

• Collects, analyzes, and disseminates MRA performance data through clear presentations and comprehensive reports, including outreach priorities, HCC gap data, and encounter status insights for utilization in Joint Working Groups (JWGs) with both internal and external stakeholders.

• Collaborates with internal and external coding, analytics, and clinical teams to ensure precise and complete diagnosis coding and HCC Gap Closures.

• Regularly presents progress and outcomes to leadership.

• Assists with CMS Risk Adjustment Data Validation activities to ensure that our external physicians and Alignment Healthcare are prepared for audits and will pass them successfully.

• Continually updates all Risk Adjustment materials to reflect changes in clinical and/or official guidelines.

• Proposes, revises, and enhances clinical educational resources to support the training of physicians and clinical staff on Risk Adjustment Healthcare Programs, including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation.

• Recommends customizations of Risk Adjustment education tailored for various audiences, such as Support Staff, PCPs, Specialists, Employees versus contracted personnel, and Central Departments.

• Remains updated on industry coding, compliance, and HCC issues.

• Utilizes, safeguards, and reveals Alignment Healthcare patients’ protected health information (PHI) only in compliance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• Enhances professional and technical knowledge by attending educational workshops, reviewing professional literature, establishing personal networks, and engaging in professional societies.

⛳️ Requirements

• Three to five years of coding experience in a medical group or health plan environment is required.

• Professional coding experience is essential.

• Experience in strategic planning for risk mitigation is necessary.

• Proficiency in the MS Office suite, including Access, is required.

• Previous experience using Epic, Allscripts, or EZCap is a plus.

• A Bachelor’s degree in business administration, healthcare management, or a related field, or equivalent experience is required.

• A current driver’s license is necessary.

• Certification such as CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, or CPMA is required.

🏝️ Benefits

• Local travel is required.