Health Risk Education Consultant

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A Brief Overview

Position Summary

Shift Monday-Friday standard business hours. No holidays and no weekends.

Fully remote in the USA.

Travel to NY up to 5%.

Develops strategy with internal business partners to build relationships with local network and health care management teams to educate, train, and support physical practice groups that serve the organization's commercial exchange membership in support of risk adjustment. Applies advanced clinical knowledge and skills to assess, plan, monitor, and evaluate healthcare services in the provider office setting. Coaches provider sites and regions on best practices in risk adjustments.

Utilize clinical documentation skills to support efforts to improve the overall quality and completeness of clinical documentation in outpatient physician practices. Responsible for ensuring accurate, timely, and quality clinical documentation in the medical record to reflect the health status of patients and the care they receive. The ideal candidate will be responsible for chart reviews of electronic health records for conflicting, incomplete, or nonspecific provider documentation as it relates to appropriate HCC code capture and for educating providers as a result of chart reviews. Performs audits of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation. Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the national team, and help facilitate gains in efficiency and appropriate risk score capture. Identifies opportunities to promote quality. Shares best practices in risk adjustment across all sites/regions. Simultaneously manages multiple, complex projects. Facilitates improvement in the overall quality, completeness and accuracy of medical record documentation. Reviews charts to assess the clinical status of patients, current treatment plan, and past medical history to identify potential gaps in clinical documentation related to outpatient encounters, with a particular focus on primary care visits. Performs on-site or electronic coding and clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding. A particular focus with be on Hierarchical Condition Categories (HCC) coding, which is used by CMS and other payers to determine illness complexity and estimate patient risk of future health care utilization. Leverages data provided by available information technology (such as billing data) to identify additional opportunities to improve the comprehensiveness and specificity of outpatient coding. Communicates compliant queries to the physician/provider as related to conflicting, incomplete, non-specific documentation and analyzes the returned query response for accuracy and completeness.

Position will potentially have minimal regional travel to CVS ACO REACH provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes Microsoft Office Suite and knowledge of various EMR platforms.

Required Qualifications

- CPC certification

- 3 years risk adjustment experience in Medicare advantage or commercial

- 3 years of provider education experience

- Knowledge of regulatory/accreditor guidelines

- 3 years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.

- 3 years experience with ICD-10 codes

- 3 years experience/understanding of electronic medical records/electronic health records in the office setting required.

- 3 years experience sending compliant queries

Preferred Qualifications

- CRC certification

- CPMA certification

- CIC certification

Education

High school diploma or GED

Bachelor's degree preferred

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Salary : $66,575 - $142,577