Risk Adjustment Data Entry

Gonzaba Medical Group•San Antonio, TX

5d•Onsite

About The Position

This role focuses on improving documentation of acuity for the capitated GMG patient population through the Review Medical History (RMH) process, intake visits, and other outreach efforts. The position also supports other Managed Care projects. It has no supervisory responsibilities. The role is based in a clinic environment and involves exposure to conditions common to a clinic, including communicable diseases, bodily fluids, toxic substances, ionizing radiation, and medicinal preparations. Physical requirements include manual dexterity; sitting, standing, stooping, reaching, kneeling, crouching, bending, and walking; lifting up to 15 pounds; close vision and the ability to adjust focus; and working efficiently under pressure. Team members are expected to work accurately and promptly, maintain clinical competencies according to Gonzaba Medical Group policy, communicate courteously with patients, visitors, providers, and co-workers, and follow customer-service expectations for in-person, telephone, and telehealth interactions. The role also requires adherence to confidentiality and HIPAA requirements. Other duties may be assigned as the position's needs evolve.

Requirements

Minimum high school education or equivalent.
Skilled in using computers and EMR systems.
Knowledge of word processing, spreadsheet, internet, and database software.
All duties must be performed accurately and in a timely manner.
Must be able to work efficiently under pressure.

Nice To Haves

Medical Assistant Certificate or current Texas LVN license.
CPR with AED certification.
At least one year of experience in a clinic, doctor's office, or hospital.

Responsibilities

Maintain an accurate database of GMG capitated patients and update it monthly using enrollment and disenrollment reports.
Update the database to track each stage of the RMH process and support accurate reporting.
Prepare audit documents and create logical batches for reviewers.
Process completed audits for timely entry into the EMR.
Help teach clinical staff to identify patients needing RMH review, prepare RMH notes for providers, process RMH encounter notes, and schedule future RMH appointments appropriately.
Keep PCPs, clinical staff, and Managed Care team members informed of pertinent findings and issues.
Track and report completed RMH dates of service (DOS) for CMS submission.
Support team members across the Risk Adjustment process so timelines and departmental goals are met.
Review reports to identify areas for improvement or action needed to meet departmental goals.
Participate in other Managed Care projects, including marketing events and the Medicare Open Enrollment period.
Maintain clinical competencies according to Gonzaba Medical Group policy.
Follow customer-service expectations and confidentiality and HIPAA requirements.
Perform other duties as assigned.