Address
Form of workPosition Purpose:
Under the direction of the Risk Adjustment Supervisor, this position is accountable for the education and support of network providers regarding the health plan performance programs such as Medicare/ACA Risk Adjustment, HEDIS, CAHPS and plan STAR ratings. The position will provide on-site support and education to networked healthcare providers in order to increase performance based on data surrounding HEDIS, CMS Star measure gap closure, Risk Adjustment improvement initiatives and proper medical record documentation. The position will be responsible for developing and maintaining effective working relationships with healthcare providers, their office staff, and internal stakeholders.
Nature and Scope:
This position is responsible for improving network provider performance as measured by regulatory agencies overseeing programs such as Medicare/ACA Risk Adjustment, HEDIS, CAHPS and plan STAR ratings. The role will require developing, implementing, and maintaining initiatives through the education, support and outreach to network healthcare providers. The position will involve a significant amount of claim analysis, medical record review, CMS regulation research and IT specification review for accurately educating and supporting healthcare providers to optimize the performance on all health plan performance initiatives. This position will also be expected to identify and enhance the quality of networked provider medical record documentation opportunities and will be responsible for both face to face provider education and group meetings as appropriate. The position will utilize new technology, as appropriate, for efficient delivery of services and to make informed decisions based on data, to drive performance metrics across all health plan performance initiatives.
The position will require training providers and their office staff on the use of internal resources/tools while increasing the utilization of the internal resources/tools to maximize engagement in the Quality is Premium program and the Provider Portal. The position will provide support with managing the development, implementation, compliance, and oversight of Hometown Health's Performance Management Programs. Components of this position include URAC accreditation, Risk Adjustment, STARS, HEDIS, Member Satisfaction, and Fraud, Waste, and Abuse.
This position will perform other duties as requested. The essential functions of the position are:
This position does not provide patient care.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications:
Education: Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor of Science in Nursing, Public Health, Business, Health Care Administration, or health-related discipline required.
Experience: Experience with HEDIS, CAHPS, Stars and Risk Adjustment is preferred. Experience working with Medicare program in a Health Plan setting is preferred. Minimum of five years of clinical experience required.
License(s): Current and unrestricted State of Nevada Registered Nurse license. Ability to obtain within 90 days a valid State of Nevada driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.
Certification(s): A current coding certification recognized by AAPC, AHIMA or other nationally recognized coding certification is preferred.
Computer / Typing: Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also, must have a working knowledge of Microsoft Office products.
Under the direction of the Risk Adjustment Supervisor, this position is accountable for the education and support of network providers regarding the health plan performance programs such as Medicare/ACA Risk Adjustment, HEDIS, CAHPS and plan STAR ratings. The position will provide on-site support and education to networked healthcare providers in order to increase performance based on data surrounding HEDIS, CMS Star measure gap closure, Risk Adjustment improvement initiatives and proper medical record documentation. The position will be responsible for developing and maintaining effective working relationships with healthcare providers, their office staff, and internal stakeholders.
Nature and Scope:
This position is responsible for improving network provider performance as measured by regulatory agencies overseeing programs such as Medicare/ACA Risk Adjustment, HEDIS, CAHPS and plan STAR ratings. The role will require developing, implementing, and maintaining initiatives through the education, support and outreach to network healthcare providers. The position will involve a significant amount of claim analysis, medical record review, CMS regulation research and IT specification review for accurately educating and supporting healthcare providers to optimize the performance on all health plan performance initiatives. This position will also be expected to identify and enhance the quality of networked provider medical record documentation opportunities and will be responsible for both face to face provider education and group meetings as appropriate. The position will utilize new technology, as appropriate, for efficient delivery of services and to make informed decisions based on data, to drive performance metrics across all health plan performance initiatives.
The position will require training providers and their office staff on the use of internal resources/tools while increasing the utilization of the internal resources/tools to maximize engagement in the Quality is Premium program and the Provider Portal. The position will provide support with managing the development, implementation, compliance, and oversight of Hometown Health's Performance Management Programs. Components of this position include URAC accreditation, Risk Adjustment, STARS, HEDIS, Member Satisfaction, and Fraud, Waste, and Abuse.
This position will perform other duties as requested. The essential functions of the position are:
- Educate networked providers, office staff and internal stakeholders on all health plan performance initiatives that support regulatory requirements for programs such as Medicare/ACA Risk Adjustment, HEDIS, CAHPS and plan STAR ratings.
- Educate and audit network providers, office staff and internal stakeholders on medical record documentation and ICD-10 coding.
- Ability to deliver and improve provider specific metrics for all health plan performance initiatives.
- Collaborate with the Risk Adjustment Coders to explain disease processes and diseases interactions for coding purposes
- Focus on closing care gap opportunities that support the health plan performance initiatives.
- Collaborate with providers to improve practice performance and increase engagement for both the provider and the member.
This position does not provide patient care.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications:
Education: Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor of Science in Nursing, Public Health, Business, Health Care Administration, or health-related discipline required.
Experience: Experience with HEDIS, CAHPS, Stars and Risk Adjustment is preferred. Experience working with Medicare program in a Health Plan setting is preferred. Minimum of five years of clinical experience required.
License(s): Current and unrestricted State of Nevada Registered Nurse license. Ability to obtain within 90 days a valid State of Nevada driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.
Certification(s): A current coding certification recognized by AAPC, AHIMA or other nationally recognized coding certification is preferred.
Computer / Typing: Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also, must have a working knowledge of Microsoft Office products.
