Alpine Physician Partners

Risk

• Responsible for educating and advising providers and practice staff in Medicare coding guidelines, focusing on revenue enhancement opportunities.
• Work in collaboration with other PHP departments and Optum/United HealthCare Medicare Advantage(MA) or other health plans to develop plans and materials that support education and system changes to meet practice and IPA revenue goals.
• Collaborates to develop plans and present to practices the HCC education program that reflects IPA ethical standards and Medicare guidelines.
• Collaborate with Optum and PHP data analysts to develop meaningful practice-level reporting to assist in coding and code submission more effectively.
• Work with contracted Medicare Advantage plans, Optum and other third party vendors to drive or supplement educational forums and reports.
• Identify potential data flow obstacles within assigned practices and work with practice staff to develop action plans to assist practices in overcoming obstacles.
• Identify and solve issues with other vendors (billing companies, clearinghouse, etc.) to remove obstacles that prevent maximum code extraction and submission.
• Risk adjustment chart reviews.
• Educate physicians and office staff on coding techniques to accurately document and capture patient acuity to the highest degree of specificity while maintaining Medicare guidelines.
• Maintains working knowledge of changing health industry environment related to the risk adjustment model and CMS expectations such as tolerance, fraud/abuse responses, etc.
• Remain current on CEUs to maintain CPC and other professional certifications.
• Be a primary resource for physicians and office staff to answer questions or access resources to support documentation and coding for risk adjustment.
• Interface with assigned practices on a regular basis to help develop and maintain engagement levels of practices.
• Build relationships with practices to help them understand the importance of documentation and coding in a manner that addresses overall patient care management and IPA revenue goals.

Risk Adjustment Educator

Director

• Leverage analytics to identify, facilitate, and empower enterprise-wide performance initiatives
• Partner closely with senior leadership, business units / MSO functions, and technical teams to ensure their performance needs and priorities are met
• Generate and Share Performance Insights with Business Units and MSO Functions: Design, synthesize, and execute analytics that surface performance opportunities and variances for business units and functional leaders
• Design and Evolve Analytics to Map to Business Needs: Partner with internal data and reporting functions to scope analytics to clearly map to specific current and future business use cases, with a focus on usability and translation into actionable insights
• Stakeholder Collaboration: Partner with stakeholders across the organization – both technical functions responsible for loading data and producing reporting – as well as business unit leaders and MSO executives who consume those reports – to translate data and reporting into actionable performance opportunities
• Partner with MSO functions to ensure their key performance needs are met
• Technology & Tools: Evaluate, implement, and optimize performance management and analytics tools to streamline processes and improve user experience
• Change Management: Lead change initiatives related to performance reporting and analytics, ensuring effective communication, training, and adoption across the organization
• Build and mentor a team of analytics professionals, fostering a culture of innovation, collaboration, and continuous improvement

Risk Adjustment Educator

Director, Performance Enablement, Analytics