Accountable Care Organization REACH Health Education ...

Job DescriptionCandidates preferred in New York, Florida, and Illinois. Involved in ACO (Accountable Care Organization) clinical documentation and coding initiative planning, ongoing client relationship management and satisfaction for assigned initiatives that impact the delivery of products and services to the internal and external environment. Collaborates with external vendors, external consultants, consulting team members and/or matrixed staff as required in support of initiatives. Accountable for transferring knowledge, best practices (external and internal), methodology and tools to client organizations. Participates as a team member, may be responsible for concurrent initiatives or act as team lead for less complex projects based on resource requirements. Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions) Participates in influencing client contracting process, builds optimal client relationship for results and deliverables and manages relationship throughout engagement Participates and supports metrics integration and execution for optimal results. Shares joint accountability for initiative's return on investment Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities Participates in initiative planning as required. Supports engagement using a disciplined repeatable methodology Designs, develops interventions, and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials Gathers, analyzes, and synthesizes business intelligence to drive achievement of strategic business objectives Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer Responsible for educating providers on how to properly document HCC conditions and interventions received during face-to-face member encounters, including proper coding and claim submission for services rendered. Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers. Performs reviews of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation for ACO REACH Model. Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the l market team, and help facilitate gains in efficiency and appropriate risk score capture. Leads work groups to develop learning strategies to improve health care delivery performance. Serves as the training resource and subject matter expert to regionally aligned practices. Identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps. Identifies opportunities to promote quality. Shares best practices in accurate clinical documentation across all sites/regions. Simultaneously manages multiple, complex projects. Position is sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.Required Qualifications CPC (Certified Professional Coder) certification and CRC (Certified Risk Adjustment Coder) certification 5+ years of experience navigating EHR (electronic health records), including medical record documentation review, diagnosis coding, and auditing. Willing and able to travel to ACO REACH provider offices, clinics, and facilities. 5+ years of computer experience, which includes navigating multiple systems and keyboardingCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Bachelor's degree preferred 5+ years' experience with one or more of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, strategic business planning, and/or risk coding management consulting. Experience with ICD-10 codes. Experience with Medicare and/or Commercial risk adjustment process. Knowledge of regulatory/accreditor guidelines Knowledge of quality of care Demonstrated experience successfully implementing change in complex organizations. Operational experience in a relevant discipline Effective communication skills required, both verbal and written. Ability to multi-task, prioritize and effectively adapt to a fast-paced changing environment Team leadership and team building skills. Analytical and planning skills. Negotiation/influencing skills. Relationship and change management skills. . Time management skills and critical thinking skills.Education- Associate's degree required, or, equivalent experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19