Blanchard Valley Health System · 1 day ago
Provider Education & Risk Adjustment Manager (FT Salaried)
Findlay, OH
Contract
Hybrid
Mid, Senior Level
3+ years expBlanchard Valley Health System is seeking a Provider Education and Risk Adjustment Manager to lead provider education and documentation initiatives for value-based programs. The role involves developing education programs, collaborating with clinical departments, and ensuring compliance with regulatory requirements to support optimal reimbursement and quality metrics.
Health CareHospitalNursing and Residential Care
Responsibilities
Designs and implements education programs for physicians, APPs, and clinical staff to support documentation best practices, ICD-10 coding, HCC capture, RAF scoring, payer requirements and quality reporting
Collaborates with clinical departments to develop prospective, concurrent and / or retrospective workflows and processes through documentation improvement initiatives (CDI) to support comprehensive and specific capture of conditions to support optimal reimbursement, value-based programs, and quality reporting metrics. Implements processes for annual condition recapture, suspect analytics validation, and closing documentation gaps for chronic conditions
Creates and implements new provider onboarding program, including audits performed at regular intervals to identify coding and documentation opportunities; provides feedback and education to provider based findings
Provides department and one-on-one provider coaching based on data insights (e.g., chronic condition / HCC capture, suspected conditions, identified documentation gaps, etc.). Supports education through various provider friendly communication methods and tools, such as creation of presentations, reference guides, newsletters, key performance indicators, etc
Collaborates with HIM coding leadership and coding auditor and educator to identify coding opportunities to support HCC capture / risk adjustment coding; works with coding leadership to identify and initiate coder training and education on needed
Collaborates with IT, provider oracle training team and internal teams to evaluate system optimization opportunities and implementation of tools to support provider in documentation accuracy and efficiency (e.g. creation of templates, upfront tools to support provider code selection and specificity, processes to capture chronic conditions, etc.)
Serves as a liaison with the CIN/ACO to support compliance with value-based care models, representing coding & documentation practices on behalf of BVHS and to address coding & documentation opportunities identified associated with RAF score
Establishes dashboards and KPIs for documentation accuracy, coding quality, RAF trends, condition recapture, and quality metrics
Ensures compliance with regulatory requirements, including CMS, OIG, payer contracts, AHIMA Standards of Coding Ethics, HIPAA and internal policies
This job description reflects the general nature and expectations for the position. It is not an exhaustive list of activities, duties, or responsibilities involved. The incumbent may be asked to perform other related duties as needed
Qualification
Required
Degree in Health Information Management, Nursing, Healthcare Administration, Health Informatics or other related field or equivalent work experience
Three years' experience in HCC/risk adjustment related coding, clinical documentation improvement, provider and/or value-based care
Required credentials include Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certification in Outpatient Clinical Documentation Integrity (CDEO or CCDS-O), or equivalent credentials or obtained within 12 months of starting position
Hybrid work position with travel required between medical practices in the BVHS service area
A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within 30 days of your residency in the state). You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle
Possess advanced understanding of coding classification systems (ICD-10-CM, CPT, HCC, etc.), thorough knowledge of revenue cycle and reimbursement processes, including risk adjustment methodologies
Understand audit standards and process, ability to perform trend analysis to identify opportunities and create actionable items to demonstrate improvement
Strong knowledge of regulatory and compliance requirements; ability to seek out and research coding related topics through resources such as Coding Clinic, CPT Assistant, CMS websites, CIN/ACO resources, etc
Ability to work independently and meet deadlines
Ability to provide clear, concise, and effective education to individuals or groups. Skill in analyzing and effectively presenting data and complex information to various audiences, including leadership. Ability to build trust and credibility
Capable of managing multiple tasks/projects with excellent organizational, time management, and prioritization skills. Self-motivated
Proven proficiency with computer applications, including Microsoft Office (Excel, Word, PowerPoint), and healthcare-specific tools like Encoder
Thrives in a fast-paced, creative environment, moving independently between tasks
Makes sound decisions quickly, maintains professional conduct, and works well with others on both individual and team levels
Positive service-oriented interpersonal and communication skills required
Preferred
Experience with integrated health systems, ACOs, or Medicare Advantage plans, HHS ACS risk adjustment programs
Familiarity with EHR workflows (e.g., Epic, Cerner) and clinical analytics tools (e.g., payer RAF portals, STARS dashboards)
Experience with Oracle (Cerner) and 3M 360E CAC program
Company
Blanchard Valley Health System
Blanchard Valley Health System is a health system that offers a continuum of care as per the needs of the community with quality services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Myron Lewis Lewis
President & CEO
Recent News
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