Health Risk Adjustment Coder

Blue Zones Health, formerly Healthly, is a primary care delivery model that focuses on treating the underlying causes of chronic disease and helping reduce dependence on medications and surgery. Our approach to healthcare combines insights from 25+ years of Blue Zones' identification and research into the longest-lived peoples and application of that research to improve well-being at the population level, with the American College of Lifestyle Medicine's evidence-based physician training and certifications. In a peer reviewed study, we demonstrated our model's ability to meet the IHI Triple Aim of better patient outcomes, for lower cost, with greater patient satisfaction. Because our innovative model reduces the need for high-cost invasive care, we redeploy dollars into proactive prevention and disease reversal programs which allows us to offer our services at no or low additional cost for patients with participating insurances and Medicare. Our employed and affiliated physicians provide patients with personalized care pathways based on the Blue Zones Power 9 principles, including support groups, classes, and access to experts such as dieticians and coaches. To find out more about how we empower patients, physicians, providers, and people to Live Better, Longer™, visit www.bluezoneshealth.com.

Position Summary: Owns assigned client relationship, acts as a subject matter expert, and oversees the development and facilitation of the implementation of new and existing healthcare Risk Adjustment & Quality strategies at an advanced level. Guides and influences other departments and the lead on quality and risk adjustment initiatives. Local Provider support for short- and long-term strategy, program planning and implementation, patient campaigns, outreach tactics, facilitation educational programs, data collection efforts and develops and monitors key performance measurement activities.

Responsibilities include:

• Accountable for programs including all aspects of the various methods of executing on a Medicare Risk Adjustment (MRA) strategy (e.g. prospective, retrospective, concurrent approaches).
• Lead risk adjustment operational programs aimed at monitoring, oversight, and compliance for risk score accuracy
• Responsible for the program to meet full compliance with state, federal and partner requirements.
• Drives industry best practices and performance results focusing on driving key KPIs (i.e. # visits, RAF score, AWV completion rate, coding accuracy chart reviews and HCC recapture)
• Manage a coordinated, cross functional and integrated processes across the organization to implement programs and streamline activities.
• Drive program goals and key performance indicators (KPIs) to ensure accountability across the organization.
• Partner with Finance, Analytics, and Vitality team to establish risk adjustment analytics for coding improvement opportunities, provider coding improvement opportunities, provider coding accuracy, risk score trending and tracking.
• Ensure accurate coding for documentation and chart reviews.
• Drive effective chart review documentation practices
• Educate both internal staff and provider groups to drive appropriate action and closure of identified care gap opportunities.
• Collaborate with payer partners, manage key vendor relationships, and perform oversight of vendors for performance management and service level adherence for assigned practices
• Ensure processes and tools required for best-in-class accurate recapture rate
• Assist provider engagement and operations teams to maximize efficiency for provider conducted risk and quality visits.
• Oversee and manage the compliance and performance of vendors or third-party administrators performing risk adjustment activities.
• Perform other duties as assigned

Please note that the responsibilities listed above are not exhaustive and may change in line with organizational needs.

Required Education and Experience

Licenses/Certifications

• Coding certification required through AHIM or AAPC (at least one of below):
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist for Providers (CCS-P), or Registered Health Information Management Technician (RHIT)
• At least 2 years of provider/medical operations experience in value-based care setting with risk adjustment coding experience, and value-based care methodologies to improve clinical and cost of care performance.

Skills:

Prior experiences teaching/training others on correct coding and other evidence-based guidelines to drive clinical and cost of care performance and present to large groups of Physicians/Providers.

• Strong computer and analytical skills (i.e., MS Word, PowerPoint, Excel) and ability to convey updated business requirements to advance reporting metrics
• Must be a strong public speaker with excellent written and verbal communication skills and experience effectively delivering subject matter expertise to a large audience of providers and internal staff.
• Ability to manage concurrent projects by understanding and reporting on key program performance metrics and ability to prioritize value levers based on expected clinical/fiscal impact
• Ability to work with multidisciplinary teams and provide support to operational leaders on initiative delivery and implementation
• Ability to articulate business requirements cross functionally and analyze data trending to propose tailored strategies to specific provider groups.

Working conditions:

While performing the duties of this job, the employee works in normal office working conditions.

Travel

Work from home position with travel to assigned practices scheduled per needs of the business. Must live locally in Inland Empire.

Full time

Location: Remote, USA - (Inland Empire) with travel to provider practices locally 2-3 days a week.

Job Type: Full-time

Pay: $70,000.00 - $90,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance
• Volunteer time off
• Work from home

Schedule:

• Monday to Friday

Experience:

• Risk Adjustment: 2 years (Preferred)

Ability to Commute:

• Inland Empire, CA (Required)

Willingness to travel:

• 50% (Required)