Senior Risk Adjustment Coder – Government Programs
Capital Blue Cross
Quality Manager
Wellvana
full-time
Posted on:
Origin: • 🇺🇸 United States • Tennessee
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Obtain and analyze the baseline assessment of clinical and EHR workflows of each assigned partner
- Work with partners to further develop workflows and ensure documentation meets unique reporting requirements
- Ensure partners are knowledgeable with the Wellvana Universal Measure Set and differences from end-of-year reporting
- Monitor performance monthly through a standard reporting package and develop actionable next steps for continuous improvement
- Data optimization and performance enablement; deliver and assist with interpretation of technical requirements for each program
- Ensure supplemental data is uploaded to payor portals as applicable
- Deliver strategies utilizing industry best practices and clinical pathways to meet and exceed measure benchmarks via webinars, guidebooks, and 1:1 support
- Provide ongoing education to Partner Success and Growth teams around annual metric changes
- Partner with internal teams to deploy ACO REACH/PC FLEX data reporting
- Participate in special projects (e.g., MIPS for Prospective Partners), attend JOCs, monthly quality calls, and action planning meetings
- Collaborate with external vendor to ensure end of year quality reporting is evaluated and submitted based on overall ACO score
Requirements
- Deep understanding of CMS measure technical specifications and previous quality experience
- 3-5 years in a healthcare related field
- Bachelor’s degree in a related field and/or the equivalent combination of training, education, and experience, required
- Strong time management and organizational skills. Able to meet assigned deadlines.
- Knowledge of CMS program requirements for each line of business - ACO, MSSP and Medicare Advantage
- Integrity: The right way is the only way
- Dependability: You do what you say you’re going to do
- Advocacy: You fight for the best possible outcome for providers and their patients
- Clarity: You make it all understandable
