locations
Oak Brook Support Center - 2025 Windsor Dr
time type
Full time
posted on
Posted Today
time left to apply
End Date: May 30, 2025 (2 days left to apply)
job requisition id
R153546
Department:
39740 Accountable Care Admin - Condition Management & Documentation
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
At this time the position is remote but may require occasional travel to practice sites across Illinois.
Job Profile Summary
Coordinates, facilitates, implements and participates as a subject matter expert within the organization for Condition Management & Documentation (CMD). The role is responsible for education, performance improvement planning and monitoring the comprehensive Condition Management & Documentation plan for AAH. This is an enterprise role with primary focus on contracts held by APP and employed Medical Groups. The role partners closely with the Coding and Auditing teams. This role implements new and existing healthcare CMD strategies, provides education and workflow recommendations to providers, identifies EHR CMD related opportunities, troubleshoots and tests CMD related EHR enhancements and conducts data collection; and is responsible for monitoring key performance measurement activities.
Job Description
Major Responsibilities:
Develops, coordinates and implements the strategic direction of the CMD program as it relates to the education for Advocate Aurora Health and Advocate Physician Partners. This includes providing education, consultation and direction to the providers and all levels of the organization as it relates to managing clinical risk.
Develops, standardizes, maintains and implements risk adjustment training programs, materials, websites and workflows for all areas of the organization to achieve CMD program goals.
Serves as the subject matter expert and internal primary point of contact for all Condition Management & Documentation related topics and guidance by maintaining an expert level of knowledge of Medicare and risk-based reimbursement methodology including CMS & IMO updates affecting HCCs, ICD 10 coding practices, Medicare/HHS risk adjustment models, Hierarchical Condition Categories (HCCs) and Risk Adjustment Factors (RAFs), clinical/charge capture functionality, internal processes and maintains professional and technical knowledge through webinars, workshops, professional publications and personal networking.
Works with coding/coding auditors to develop work ques/rules to identify CMD related focus areas for querying and missed codes and coordinate manual chart reviews of a practice to analyze clinical documentation to identify patterns and trends to develop appropriate Performance Improvement plans.
Participates with coding and compliance in risk-adjustment chart reviews including RAD-V/RACCR audits to identify patterns and trends and shares findings as appropriate.
Participates in EHR updates related to CMD IMO/best practice alerts (BPA’s)/suspect condition and grouper updates from CMS and has knowledge of clinic workflows and Epic workflows to be able to troubleshoot for informatics, test new EHR CMD related programming and put forth possible solutions.
Develops and maintains effective internal relationships through effective and timely communication.
Data mines & synthesizes raw data and organizes key performance indicators, presents information, and provides summary of material. Provides analysis and reporting on progress and results including the overall re-evaluation rate, improvement strategies and tactics.
Collaborates with quality, operations and providers to develop recommendations to complete PDSA/Improvement plans to drive CMD improvement that includes creating tools and reports to meet CMD goals.
Collaborates with other stakeholders such as: IT, Population Health, Quality Improvement, Advocate Physician Partners Compliance, IP CDI, Coding and Informatics, other members of the CRA Team, Primary Care and Specialty Service Lines to develop new EHR tools, optimize existing functionality, identify clinical documentation and coding opportunities and develop system processes that work with the designated EHR.
Licensure, Registration, and/or Certification Required:
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
Registered Nurse license issued by the state in which the team member practices, or
Certified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC). needs to be obtained within 1 year.
Education Required:
Bachelor's Degree in Health Information Management, or
Bachelor's Degree in Nursing or related field.
Experience Required:
Typically requires 5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)
Knowledge, Skills & Abilities Required:
Ability to lead programs interacting with all levels of the organization
Medicare Advantage knowledge strong preference
Strong knowledge of ICD diagnoses coding guidelines and Medicare Risk Adjustment Payment Methodology related to HCC/RAFs
Professional experience influencing changes in behavior.
Knowledge of payor plan requirements and impact to RAF scores as it relates to MSSP and Medicare Advantage programs.
Knowledge of EPIC and reporting solutions
Ability to operate in a fast-paced, dynamic environment.
Detail oriented; possess strong initiative, problem solving skills and ability to set/manage multiple priorities to meet deadlines in an expedient and decisive manner with minimal supervision.
Intermediate proficiency in Word, PowerPoint, Excel, Outlook including ability to create pivot tables, formatting, sorting, create sheets with formulas (sum, vlookup)
Strong verbal/written communication skills; ability to present in front of a group; ability to translate coding/EHR issues in plain language to providers via tip sheets, case studies, in person/emails.
Excellent organizational capabilities to execute projects/program and work effectively as a team player.
Strong aptitude for critical thinking and demonstrated analytical and data skills. Willingness to acquire new knowledge from an unfamiliar domain.
Physical Requirements and Working Conditions:
Must be able to drive to various sites throughout the Advocate Aurora Health footprint so therefore will be exposed to weather and road conditions.
Ability to work from home or in office setting.
Operates all equipment necessary to perform the job.
Exposed to normal office environment.
Pay Range
$37.50 - $56.25
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and more
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.