39740 Population Health - Condition Management & Documentation
Full time
Yes
40
Schedule Details/Additional Information:
Monday through Friday, offering remote work with needed flexibility to travel.
Position is a subject matter expert in both clinical practice and risk adjustment. This role uses both clinical care guidelines, CMS coding guidelines, AHA coding clinics, and standards of compliance to improve the overall quality and completeness of the medical record. Works collaboratively with the Condition Management and Documentation staff to communicate identified gaps in their daily workflow and educate members of the CMD staff regarding documentation guidelines, coding requirements and service-line specific requirements. Works collaboratively across multiple clinical, operational, and administrative departments to offer recommendations on improving the consultant processes and workflows.
MAJOR RESPONSIBILTIES
- Develops, coordinates and implements the strategic direction of the CMD program as it relates to education for Advocate Aurora Health Care and Advocate Physician Partners. This includes providing education, consultation and direction throughout the organization as it relates to managing clinical risk.
- Serves as the subject matter expert and internal primary point of contact for the Condition Management and Documentation Consultants as it relates to Condition Management and Documentation related education topics and guidance by maintaining an expert level of knowledge of Medicare and risk-based reimbursement methodology including CMS & IMO updates affecting HCCs, ICD 10 coding practices, Medicare/HHS risk adjustment models, Hierarchical Condition Categories (HCCs) and Risk Adjustment Factors (RAFs), clinical/charge capture functionality, internal processes and maintains professional and technical knowledge through webinars, workshops, professional publications and personal networking.
- Works with coding/coding auditors to develop work ques/rules to identify CMD related focus areas for querying and missed opportunities codes and coordinate manual chart reviews of a practice to analyze clinical documentation to identify patterns and trends to develop appropriate Performance Improvement plans.
- Participates in EHR updates related to Risk Adjustment IMO/best practice alerts (BPA’s)/suspect condition and grouper updates from CMS and has knowledge of clinic workflows and Epic workflows to be able to troubleshoot for informatics, test new EHR CMD related programming and put forth possible solutions
- Data mines & synthesizes raw data and organizes key performance indicators, presents information, and provides summary of material. Provides analysis and reporting on progress and results, improvement strategies and tactics
- Collaborates with other stakeholders such as: IT, Population Health, Quality Improvement, Advocate Physician Partners Compliance, IP CDI, Coding and Informatics, other members of the CMD Team, Primary Care and Specialty Service Lines to develop education tools, optimize existing functionality, identify clinical documentation and coding opportunities and develop system processes that work with the designated EHR.
- Develops and maintains effective internal relationships through effective and timely communication
MINIMUM EDUCATION AND EXPERIENCE REQUIRED
- License/Registration/Certification Required: Clinical Risk Coder (CRC) issued by American Association of Professional Coders (AAPC).
- Education Required: Bachelor’s degree in Health Care or related field.
- Experience Required: 5 years in health care setting working with CMS HCC Model.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
- Ability to discuss clinicians and patients in an ethical manner that would reduce the potential for fraud and compliance issues.
- Ability to independently establish and maintain working relationships that will be conducive to meeting department and organizational goals. Skilled at maintaining a professional demeanor and positive attitude. Ability to address sensitive information with physicians, peers and management.
- Demonstrated knowledge of coding, billing and documentation requirements, and Centers for Medicare and Medicaid and health and Human Services risk adjustment methodologies. Maintain professional affiliations for certifications that support accurate coding, documentation and continuing education.
- Demonstrates superior critical thinking skills with ability to independently solve problems appropriately using knowledge, and current policies/procedures/ guidelines and regulations. Strong writing and presentation skills to effectively articulate trends, opportunities , compliance issues, and education.
- Strong organizational and time management skills. Ability to independently manage time to meet goals while being flexible as needed.
- Strong knowledge of Office products. Ability to learn new technology and systems as needed to perform job functions.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Pay Range
$43.30 - $64.95
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.