Address
Form of work
SalaryOverview
- Develop, implement, and maintain Risk Adjustment solution operational workflows for customers.
- Develop and maintain Risk Adjustment solution training modules.
- Develop Risk Adjustment Solutions “best practices” and assist the Implementation team and post sales consultants in applying to customer solutions.
- Assist in the product development cycle to ensure end user focus aligns with Risk Adjustment outcomes.
- Assist in the development and implementation of product specific operational specs and configurations.
- Actively participate in product improvement solutioning
- Monitor and assess accuracy of NLP/AI engines to ensure valid, clinically significant suggestion are being flagged.
- Act as a clinical and coding resource for all Risk Adjustment solutions.
- Monitor, review and notify appropriate product managers, developers and/ or engineers of changes/ updates to ICD-10-CM/CPT and HCPCS codes.
- Monitor and review regulatory publications to determine impact(s) on Risk Adjustment solutions.
- Develop and implement appropriate communication/ training regarding any pertinent regulatory changes for both internal and external customers.
- Engage and Educate clients on the products and solutions
- Serve as a resource and subject matter expert to other Risk Adjustment staff.
- Participate in industry wide learning opportunities and provide feedback to product to improve solutions based on industry standards.
- Contribute to the achievement of company goals and objectives by performing other duties as assigned.
What you will bring:
- Bachelor’s Degree in relevant health sciences field, RN preferred
- Minimum of 5 years of experience in Risk Adjustment and clinical documentation
- Experience in Medicare Compliance
- Experience in Medicare, ACA and Medicaid Risk Adjustment methodologies
- Experience with developing and managing training programs
- Must possess excellent presentation skills
- Must have a working knowledge of relevant software tools – Microsoft products
- Ability to absorb requests for change with a flexible and friendly style
- Ability to complete basic data analytics
- Excellent problem-solving skills
- CRC Certification preferred, CPC a plus
Edifecs is a premier technology company in the U.S. Healthcare market with solutions focused on interoperability, workflows, Risk Adjustment, value-based care payments, and analytics. Edifecs solutions are used by leading healthcare entities including, payers, providers, employers, third-party administrators, and government agencies. With innovative technology and solutions, Edifecs helps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of complying with regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem. Edifecs is a frontrunner in providing solutions for B2B data exchange, streamlining key workflows in areas such as enrollment, Risk Adjustment, and alternative payment models. With the advent of FHIR and new regulatory guidance from HHS, Edifecs has emerged as a leader in easing the effort associated with achieving compliance with new federal rules and in making the healthcare consumer the primary stakeholder. Edifecs solutions are offered in both On-Premise and SaaS models. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia, and Mohali, India, an engineering center in Moldova, and has more than 700 employees.
