Description

The healthcare system isn’t designed for health. We’re designed to change that.

We’re Wellvana, and we help doctors deliver life-changing healthcare.

Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it. 

Our enlightened approach—covering everything from care coordination to coding to marketing— ties the healthy outcomes of patients directly to healthier earnings for primary care providers.

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated 24/7 care that is nothing short of life changing.

Recently named by Insider as one of 33 startups “investors expect to take off in 2023,” we’re one of the fastest-growing healthcare companies in America because what we do works. 

This is the way medicine is meant to be.

The Role: 

We're looking for a Supervisor of Risk Adjustment & Quality to oversee and improve processes and to serve as our subject matter expert regarding diagnosis coding and documentation.

Responsibilities: 

• Oversee and improve the various quality and risk adjustment processes.
• Recommend and/or implements process improvements related to the potential of quality medical care and service. 
• Serves as a resource regarding government and regulatory audits, accreditation standards, and continuous quality improvement principles. 
• Actively seeks and identifies opportunities for improvement.
• Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. 
• Interprets and provides feedback on CMS regulations and HCC risk adjustments reimbursement methodology
• Ensures dissemination of clinical/reimbursement information to all key stakeholders
• Review of provider office/entity process for appropriate submission of ICD10, CPT, and HCPCS codes according to government and coding guidelines.
• Assist client with the development of a comprehensive Risk Adjustment and Quality strategy and work plan, including workflow, outcome measures, and performance evaluation.
• Facilitate the development of key quality and risk adjustment key performance indicators.
• Present quality performance results and findings regularly, including the overall measure performance, improvement strategies, and tactics.
• Serve as a quality and risk adjustment subject matter expert for internal and external clients.
• Oversees claims/encounter data collection, processing, submission, and data reconciliation efforts with provider network and health plans ensuring that collected data is processed all the way to CMS’s supplemental submission system as well as EDPS system
• Perform audits, coding, and provider education as per business needs
• Support activities of the PCV (Preventative Care Visit) and patient outreach
• Collaborates across the company and with vendors to help ensure the integration and alignment of risk adjustment strategies
• Leads staff assigned to risk adjustment; provides guidance and engagement of staff; and builds effective teams (both internally and with vendors) to achieve established goals and within established budgets
• Lead Physician educational campaigns.
• Perform other duties as assigned.
• 25% Travel required 

Requirements

• Bachelor’s degree in health-related field preferred
• Experience working with ACO/ Health Plan
• Minimum of 5 years’ experience in HCC-specific coding/auditing.
• 4 years of experience in provider education
• Experience in a broad range of HCC-related audit types and/or projects.
• Experience auditing physicians and coders.
• Experience in physician documentation/coding education. Experience in educating/training coders. ICD-10-CM Coding knowledge.
• Either CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder)
• Thorough understanding of Risk Adjustment, HCC coding, ICD coding, and RADV requirements.
• Knowledge of Medicare Advantage and other HCC entity program coding requirements.
• Proficient in Word, Excel, and Outlook.
• Excellent communication, presentation, and analytical skills.