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Risk Adjustment Specialist

2 months ago

Auburndale, United States Atrius Health Full time

Atrius Health is a nonprofit healthcare leader delivering a system of connected care that enables us to know our patients better so that we can serve them well. Across 32 clinical locations, more than 50 specialties and 825 physicians, we provide proactive, customized care to more than 720,000 adult and pediatric patients across eastern Massachusetts.

The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have.

The Atrius Health practices including Dedham Medical Associates, Granite Medical Group, Harvard Vanguard Medical Associates and PMG Physician Associates - together with VNA Care - work in collaboration with hospital partners, community specialists and skilled nursing facilities, to develop innovative and effective ways of delivering care in the most appropriate setting, making it easier for patients to be healthy.

We believe that by establishing a solid foundation of knowledge, understanding and trust with each of our patients, we enrich their health and enhance their lives.

SUMMARY

Under general direction, conducts medical record reviews to ensure that all documented chronic disease (HCC) diagnoses are captured allowing the opportunity for optimal health risk scores. Reviews clinical data from EpicCare and outside claims to ensure that all chronic disease (HCC) diagnoses have been identified and appropriately captured on the patient's medical record problem list. Reviews medical record documentation to be sure all chronic conditions on the problem list are substantiated before missing diagnoses are added. Works closely with regional and site clinicians to ensure that all relevant clinical diagnoses are captured in electronic medical record. Is an active member of the Risk Adjustment Team, participating in creating and implementing new initiatives for Atrius Health risk adjustment programs.

EDUCATION/LICENSES/CERTIFICATIONS

Graduate of a state-approved school of nursing as an R.N or N.P., or Graduate of a State-approved program/school for Physician Assistants (P.A). Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) preferred with the requirement to obtain certification while working in the position.

EXPERIENCE

At least 3 to 5 years nursing experience with at least three years of clinical experience with chronic disease patient population in an ambulatory or inpatient setting required. Experience in a variety of specialties and multiple diseases within each specialty preferred.

SKILLS

Understanding of medical and business side of healthcare operations required. Strong analytic skills. Strong computer skills and ability to navigate using an electronic health record. Strong oral and written communication skills

Atrius Health is committed to a policy of non-discrimination and equal employment opportunity. All patients, employees, applicants, and other constituents of Atrius Health will be treated with respect and dignity regardless of race, national origin, gender, age, religion, disability, veteran status, marital/domestic partner status, parental status, sexual orientation and gender identity and/or expression, or other dimensions of diversity.

Benefits Include:

* Up to 8% company retirement contribution,

* Generous Paid Time Off

* 10 paid holidays,

* Paid professional development,

* Generous health and welfare benefit package.

Atrius Health is an equal opportunity/affirmative action employer and does not discriminate in recruiting, hiring, training, promoting or any other employment practices on the basis of race, color, religion, sex, marital status, age, sexual orientation, gender identity, national origin, military service or application for military service, veteran or disability status.

Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA);Equal Employment Opportunity (EEO); and Employee Polygraph Protection Act (EPPA).

VEVRAA Federal Contractor

Request Priority Protected Veteran & Disabled Referrals for all of our locations within the state

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