Clinical Condition Documentation Panel Management Analyst

POSITION DESCRIPTION:

The CCD Panel Management Analyst supports the Population Health – Clinical Condition Documentation (CCD) Team by managing administrative, operational, and patient support activities for divisional panel assignments, focusing on Accountable Care Organization (ACO) and Alternative Payment Model (APM) populations. This role involves providing analytic, reporting, project leadership, and problem-solving support to improve performance in Annual Wellness Visits (AWV) and Hierarchical Condition Categories (HCC). The Analyst contributes to the success of CCD programs by organizing and coordinating health improvement metrics and requirements from relevant payers, ensuring accurate and efficient chronic disease management and coding. Additionally, this role includes leading projects related to new and existing risk coding incentives.

ESSENTIAL JOB FUNCTIONS:

1. Provides systematic monitoring of disease management databases and chronic condition coding gaps lists to identify patients in need of appointments with their primary care provider. Schedules appointments for services as needed.
2. Leads patient engagement initiatives aimed at re-engaging individuals who have been disconnected from care and strategically onboarding new patients to establish long-term relationships with their assigned primary care providers.
3. Collaborates with physicians and clinical staff to design tailored patient outreach strategies and proactively coordinate the scheduling of necessary appointments to optimize care delivery.
4. Systematically reviews health plan eligibility lists/new patient registries and invites patients into IHA for services through initiative of a welcome package per protocol.
5. Utilizes EMR Systems, health maintenance data, opportunity reports, payer portals and other data as available to validate chronic condition gaps and conduct outreach activities (e.g., targeted phone calls, appointment scheduling support, patient education, follow-up communication or pre-visit engagement) as assigned.
6. Maintains tracking of patient outreach and chronic condition gap closure.
7. Using EMR tools, initiates patient outreach via MyChart messages, phone calls, and/or via letters.
8. Actively drives improvements in practice performance by monitoring and analyzing program metrics, enhancing provider engagement, conducting patient outreach and education, and increasing patient persistency for Health Plan incentive programs, including the BCBS/BCN Advantasure Provider Engagement Coordination and Persistency Program, Priority Health Disease Burden Management Program, and Optum assessments.
9. Supports and contributes to various programs, attends and actively engages in required meetings and training sessions, and participates in committees as requested to drive organizational objectives and enhance program outcomes.
10. Performs other duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
2. Must be able to work effectively as a member of the CCD team.
3. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
4. Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
5. Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
6. Maintains general knowledge of Trinity Health Medical Group  office services and in the use of all relevant office equipment, computer and manual systems.
7. Maintains strict confidentiality in compliance with Trinity Health Medical Group  and HIPAA guidelines.
8. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respects cultural differences.
9. Uses resources efficiently.
10. If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: High School Diploma or GED. Associate degree in health-related field or relevant experience is strongly preferred.

CREDENTIALS/LICENSURE: Certified Risk Adjustment Coder (CRC) or relevant experience is strongly preferred.

MINIMUM EXPERIENCE: Minimum of 2 years’ experience in healthcare, population health management, risk coding or related field. Experience in medical group practice preferred. Experience with Accountable Care Organizations (ACO), Alternative Payment Models (APM) or similar value-based care program preferred. Customer service experience strongly preferred.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Proficient/knowledgeable in medical terminology.
2. Familiarity with chronic disease management, health maintenance data, and chronic condition coding (including Hierarchical Condition Categories – HCC).
3. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records/templates, EPIC, Microsoft Office (Excel, Access, Outlook, Word, PowerPoint), email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.
4. Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to speak before groups of people, either in-person or virtually.
5. Experience with data analysis, reporting, and working with Electronic Medical Records (EMR) systems.
6. Strong quantitative and analytic skills.
7. Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
8. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups.
9. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.
10. Ability to exercise sound judgement and problem-solving skills.
11. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
12. Ability to handle patient and organizational information in a confidential manner.
13. Ability to work overtime, as scheduled.
14. Ability to travel to other office/practice sites and meeting and training locations.
15. Successful completion of IHA competency-based program within introductory and training period.

MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, phone work and charting.
2. Physical activity that often requires time working on a computer.
3. Physical activity that occasionally requires lifting up to 20 lbs. 
4. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision, and the ability to adjust and focus. 
5. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
6. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job, at times, may operate in a typical office environment and requires frequent change and significant interaction with people (many of whom are not familiar with the medical billing and reimbursement process) which can be stressful at times.