Summary: Provides recommendations for operations across the division and manages projects and their lifecycles as assigned.
Work Schedule: Full Time Days
Responsibilities: Provides consultative services including developing the project scope, deliverables, and manages project implementation. Controls resources, risk, conflicts, timelines and costs.
Meets with stakeholders to understand the current process and optimize the workflow. Identifies, secures and coordinates resources necessary for project success.
Creates standardized processes and workflows that are viable across the region. Serves as a mentor and facilitates conflict resolution.
Designs, implements and optimizes decision trees, templates and operational workflows to meet organizational objectives.
Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
C3 liaison to MA payor parties including attending meetings and reviewing monthly performance reports
Works in tandem with health plan partner's MRA Specialists to accumulate health plan specific documentation requirements, education materials, and training techniques and incorporates these resources into C3 strategic network level program
Analyzes cost and quality data for all MA products including recommended interventions and implementing new programs
Development and management of C3's Medical Risk Adjustment Program to include a program to support auditing of documentation, coding and billing practices, in C3 primary care practices, specific to risk coding
Participates in the development of the workflows and risk coding reporting available in C3's data integration solutions powered by Epic
Maintains a database with the results of all medical chart reviews performed, with ability to report on statistics and practice progress on coding initiatives
Collaborates with internal Data Analytics and Quality Teams to create a stratified plan to work with primary care practices that have most opportunity for improvement in documentation, medical cost reduction, and quality measures
Identifies risk adjustment data flow issues that prevent maximum code submission between practices and health plan partners; works with practices to remove system and process roadblocks in the data flow
Using data sources available, including Epic solutions, to facilitate practice creation of a process to identify and maintain Chronic Condition Lists/Registries focused on cost and quality improvement projects including appropriate data feeds
Assists with all Scorecard initiatives - working with the PCP offices in capturing the coding data to support the performance on Scorecard metrics
Creates Education Series that will train practice providers, billing, and support staff, as well as internal staff, for Medical Risk Adjustment, HCC coding opportunities, and STARS quality opportunities
Develop and lead education events for external partners that affect success in C3's value based agreements
Performs other duties as assigned
Bachelor's degree in related field.
Minimum of 3 years coding related experience with an emphasis in Medical Risk Adjustment
The American Academy of Professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification required; Certified Professional Coder (CPC) only will be considered with extensive MRA experience
Certified Professional Medical Auditor (CPMA) and/or AAPC Certified Instructor preferred
Experience with setting up practice level processes in support of medical risk coding and documentation
Experience with cost and data analysis to identify areas of opportunity for improvement and implementation of programs to support
Experience with developing and administering education programs to a wide audience on medical risk coding and documentation
* Experience with several EHR systems; preferably Epic, Athena, and eCW
Practice management / clinical background / team management preferred
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Internal Number: 25894
With award-winning hospitals and facilities serving the entire Front Range, University of Colorado Health is the state’s largest and most innovative health system. By integrating the strengths of academic medicine with the finest community health care, we’re able to push the boundaries of medicine and offer our employees endless career opportunities. Here, there are no limits, except those you place on yourself. Everyone is united by their passion for discovery and their commitment to improving patients’ lives.