RN Population Health

About the role

This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization’s Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.).

Responsibilities

• Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group.
• Collaborates with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs).
• Develops and implements Risk Adjustment education and training for network physicians and practices, including documentation and coding requirements, HCCs, HEDIS quality ratings.
• Monitors and ensures tools are available post implementation.
• Collaborates with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools.
• Provides formal training and supports physicians and practices in the day to day utilization of Risk Adjustment tools throughout Banner Medical Group.
• Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools.
• Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution.
• Develops and implements recommendations to improve business processes to support and/or optimize RAF scores.
• Works collaboratively with ambulatory care management to ensure quality performance criteria expectations are disseminated so physicians and practices are equipped to meet and/or exceed clinical targets.
• Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities.
• Maintains regular meetings with BMG workforce team to review findings and develop an improvement plan to meet organizational goals.
• Partners with Risk Adjustment Quality Analysts and Educators to develop educational materials.
• Meets regularly with workforce teams to support communication and promote partnership.
• Participates in or leads Risk Adjustment projects designed to improve program offerings or address system limitations.
• This may include analysis of BMG Practice Management systems, clearinghouse routing, vendor routing and/or CMS submissions.
• Maintains oversight of data submission for attestation to CMS for Risk Adjustment.
• Analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance.
• Reviews, prepares, analyzes, and presents reports and as needed.

Requirements

Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience. Must possess a current, valid RN license in the state of practice. Must demonstrate effective relationship development skills, and ability to effectively communicate in individual and group settings. Teamwork is critical. Attentive listening and polished presentation skills are needed to effectively educate providers and practices on Risk Adjustment tools. Requires critical thinking and project management capabilities. Position requires proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems.

Qualifications

Additional related education and/or experience preferred.

Skills

Effective relationship development skills, and ability to effectively communicate in individual and group settings. Teamwork is critical. Attentive listening and polished presentation skills are needed to effectively educate providers and practices on Risk Adjustment tools. Requires critical thinking and project management capabilities. Proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems.

Benefits

N/A

Pay

$35.43 - $59.05 / hour

Schedule

N/A