Condition Management & Documentation Consultant
About The Position
Develops, coordinates and implements the strategic direction of the CMD program as it relates to the education for Advocate Aurora Health and Advocate Physician Partners. This includes providing education, consultation and direction to the providers and all levels of the organization as it relates to managing clinical risk. Develops, standardizes, maintains and implements risk adjustment training programs, materials, websites and workflows for all areas of the organization to achieve CMD program goals. Serves as the subject matter expert and internal primary point of contact for all Condition Management and Documentation related 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 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 with coding and compliance in risk-adjustment chart reviews including RAD-V/RACCR audits to identify patterns and trends and shares findings as appropriate. 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. Develops and maintains effective internal relationships through effective and timely communication. 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 including the overall RAF score, improvement strategies and tactics. Collaborates with quality, operations and providers to develop recommendations to complete PDSA/Improvement plans to drive Risk Adjustment improvement that includes creating tools and reports to meet CMD goals. 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 new EHR tools, optimize existing functionality, identify clinical documentation and coding opportunities and develop system processes that work with the designated EHR.
Requirements
- Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or Registered Nurse license issued by the state in which the team member practices, or Certified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC). needs to be obtained within 1 year.
- Bachelor's Degree in Health Information Management, or Bachelor's Degree in Nursing or related field.
- Typically requires 5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)
- Ability to lead programs interacting with all levels of the organization
- Strong knowledge of ICD diagnoses coding guidelines and Medicare Risk Adjustment Payment Methodology related to HCC/RAFs
- Professional experience influencing changes in behavior.
- Knowledge of payor plan requirements and impact to RAF scores as it relates to MSSP and Medicare Advantage programs
- Knowledge of EPIC and reporting solutions
- Ability to operate in a fast-paced, dynamic environment
- Detail oriented; possess strong initiative, problem solving skills and ability to set/manage multiple priorities to meet deadlines in an expedient and decisive manner with minimal supervision
- Intermediate proficiency in Word, PowerPoint, Excel, Outlook including ability to create pivot tables, formatting, sorting, create sheets with formulas (sum, vlookup)
- Strong verbal/written communication skills; ability to present in front of a group; ability to translate coding/EHR issues in plain language to providers via tip sheets, case studies, in person/emails
- Excellent organizational capabilities to execute projects/program and work effectively as a team player
- Strong aptitude for critical thinking and demonstrated analytical and data skills.
- Willingness to acquire new knowledge from an unfamiliar domain
Nice To Haves
- Medicare Advantage knowledge strong preference
Responsibilities
- Develops, coordinates and implements the strategic direction of the CMD program as it relates to the education for Advocate Aurora Health and Advocate Physician Partners.
- Develops, standardizes, maintains and implements risk adjustment training programs, materials, websites and workflows for all areas of the organization to achieve CMD program goals.
- Serves as the subject matter expert and internal primary point of contact for all Condition Management and Documentation related topics and guidance
- Works with coding/coding auditors to develop work ques/rules to identify CMD related focus areas for querying and missed 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 with coding and compliance in risk-adjustment chart reviews including RAD-V/RACCR audits to identify patterns and trends and shares findings as appropriate.
- 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.
- Develops and maintains effective internal relationships through effective and timely communication.
- 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 including the overall RAF score, improvement strategies and tactics.
- Collaborates with quality, operations and providers to develop recommendations to complete PDSA/Improvement plans to drive Risk Adjustment improvement that includes creating tools and reports to meet CMD goals.
- 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 new EHR tools, optimize existing functionality, identify clinical documentation and coding opportunities and develop system processes that work with the designated EHR.
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
