HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 240+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Risk Adjustment Specialist!
Position Summary:
The Risk Adjustment Specialist will be a highly engaged, self-motivated, enthusiastic and service-oriented team member who will assist our network of primary care providers in identifying and resolving gaps in clinical documentation. The ability to work in a fast-paced environment while collaborating with other teams is essential to continue providing better health to countless numbers of patients.
Essential Position Functions/Responsibilities:
- Work with third party vendor to maintain risk adjustment processes.
- Support activities to identify risk adjustment strategies and tactics, and then to implement the activity sets (Medicare, Medicaid, Exchange, and Commercial).
- Assist with developing and delivering internal and external educational materials (including provider facing materials).
- Work with claims, enrollment and Medicare teams to resolve data submission errors from Encounter Data Processing System (EDPS).
- Review pended chart requests from vendor and work both internally and externally to assist in facilitating the retrieval of charts.
- Assist in developing Risk Adjustment Data Validation (RADV) audit procedures and provide support in a RADV audit.
- Assist in developing monthly and ad-hoc reports on risk adjustment project status, both financial and operational in nature.
- Assist in developing Risk Adjustment departmental policies and procedures to support Risk Adjustment.
- Understand and adhere to all Risk Adjustment regulations and deadlines set forth by CMS.
- Perform monthly reconciliation of CMS File rejections.
- Communicate and collaborate with medical coding team regarding risk adjustment projects.
- Organize and complete internal projects related to risk adjustment coding and accuracy.
- Assist in development of provider risk adjustment training materials.
- Perform other duties as assigned.
Qualification Requirements:
Skills, Knowledge, Abilities:
- Experience in using PC-based software packages, including relational database systems, spreadsheets, word processing.
- Basic understanding of Medicare payment methodology.
- Knowledge of various CMS and NYSDOH reports including:
- MMR, MOR, RAPS Return, EDPS, Plan payment reports.
- 3M Medicaid reporting.
- Excellent analytical skills.
- Excellent written and oral communication skills.
- Highly proficient with computer skills including working knowledge of Microsoft Office.
- Highly organized.
- Ability to deal with multiple internal and external resources.
- Ability to handle tight timeframes and to meet multiple deadlines.
Training/Education:
- Bachelor’s Degree preferred, High School Diploma required.
Experience:
- 1-2 years’ experience in a healthcare setting.
Salary Information:Annual Base Compensation: $65,000-75,000
Bonus Incentive: Up to 5%, based on organizational performance.
HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Department: Risk Adjustment
This is a non-management position
This is a full time position
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