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Clinical Risk Adjustment Consultant

Company: advocate aurora health
Location: Allenton
Posted on: September 23, 2022

Job Description:

Job Profile SummaryCoordinates, facilitates, implements and participates as a subject matter expert within the organization for Clinical Risk Adjustment (CRA). The role is responsible for clinical risk adjustment education, performance improvement planning and monitoring the comprehensive Clinical Risk Adjustment plan for AAH. This is an enterprise role with primary focus on contracts held by APP and employed Medical Groups. The role partners closely with the Coding and Auditing teams. This role implements new and existing healthcare Risk Adjustment strategies, provides education and workflow recommendations to providers, identifies EHR. CRA related opportunities, troubleshoots and tests CRA related EHR enhancements and conducts data collection; and is responsible for monitoring key performance measurement activities.Job DescriptionMajor Responsibilities:Develops, coordinates and implements the strategic direction of the CRA 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 CRA program goals.Serves as the subject matter expert and internal primary point of contact for all Clinical Risk Adjustment 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 CRA 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 CRA 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 CRA 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 CRA 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.Licensure, Registration, and/or Certification Required:Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), orRegistered Nurse license issued by the state in which the team member practices, orCertified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC). needs to be obtained within 1 year.Education Required:Bachelor's Degree in Health Information Management, orBachelor's Degree in Nursing or related field.Experience Required:Typically requires 5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)Knowledge, Skills & Abilities Required:Ability to lead programs interacting with all levels of the organizationMedicare Advantage knowledge strong preferenceStrong knowledge of ICD diagnoses coding guidelines and Medicare Risk Adjustment Payment Methodology related to HCC/RAFsProfessional experience influencing changes in behavior.Knowledge of payor plan requirements and impact to RAF scores as it relates to MSSP and Medicare Advantage programsKnowledge of EPIC and reporting solutionsAbility to operate in a fast-paced, dynamic environmentDetail 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 supervisionIntermediate 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/emailsExcellent organizational capabilities to execute projects/program and work effectively as a team playerStrong aptitude for critical thinking and demonstrated analytical and data skills. Willingness to acquire new knowledge from an unfamiliar domainPhysical Requirements and Working Conditions:Must be able to drive to various sites throughout the Advocate Aurora Health footprint so therefore will be exposed to weather and road conditions.Ability to work from home or in office setting.Operates all equipment necessary to perform the job.Exposed to normal office environment.

Keywords: advocate aurora health, Milwaukee , Clinical Risk Adjustment Consultant, Healthcare , Allenton, Wisconsin

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