Sr Risk Adjustment Specialist
1 month ago
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 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 or other risk model) 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 or other risk model) 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. Acts as a mentor and role model to Risk Adjustment Specialist RNs assuring that they are practicing in accordance with department clinical guidelines for accuracy and documentation. Responsible for the quality assurance process by auditing abstracted chart and providing clinical feedback to individual staff members. 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 5 - 7 years nursing experience with 3 - 5 years in chronic disease patient population in an ambulatory or inpatient setting required. Experience in a variety of specialties and multiple diseases within each specialty required.
SKILLS
Understanding of medical and business side of healthcare operations required. Strong analytic and data interpretation skills. Strong computer skills and ability to navigate efficiently using an electronic health record. Expertise in Excel navigation and formatting. Strong oral and written communication skills. Chart auditing skills highly desirable. Ability to provide feedback and training. Prior supervisory experience preferred. Able to effectively deliver continuous accurate performance feedback that integrates all available information and input. Able to lead by example and demonstrate commitment to continued organizational process improvement.
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.
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