SUMMARY:

EDUCATION:

• Bachelors Degree in related field or five (5) years related experience

LICENSES/CERTIFICATIONS

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC)
• Certified Professional in Healthcare Quality (CPHQ)
• Licensed Vocational Nurse (LVN)
• Registered Nurse (RN)

EXPERIENCE:

• Minimum five (3) years of experience with value-based care arrangements required
• Minimum five (3) years of experience with a focus on EMR operations, use, design, and implementation
• Minimum three (2) years Risk Adjustment experience required
• Minimum three (3) years of healthcare experience with an understanding of physician needs and practice workflow
• Minimum five (3) years of medical practice management, clinical program development, clinical transformation, healthcare quality analytics and/or quality improvement
• Minimum five (3) years of experience in team management, coaching teams to drive transformative initiatives
• Minimum three (4) years of provider facing experience required
• Knowledge of CMS STAR Ratings Program requirements required
• Knowledge of Risk Adjustment required
• Knowledge of HEDIS and NCQA requirements
• Strong communication and presentation skills required
• Interpersonal skills necessary in order to interact effectively and build strong relationships with physicians, staff and all levels of management
• Computer proficiency required

SKILLS:

• Ability to prioritize workload as appropriate to ensure on‐time project completion
• Excellent verbal/written communication, interpersonal, analytic, and customer service skills
• Ability to build support for and facilitate change
• Ability to work effectively on simultaneous projects with competing priorities
• Ability to function in a team‐based work environment collaboratively and collegially
• Detail oriented; Highly organized; Committed to quality
• Ability to generate trust and build collaborative relationships with internal and external colleagues
• Ability to travel locally up to 70% with the possibility of national travel for Apex Client needs
• Familiarity with electronic health record systems’ use, design, and implementation

RESPONSIBILITIES:

• • Establish a planned care model with practices in integrating administrative, financial, and clinical systems for better performance and improved outcomes.
  • Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting.
  • Utilize available tools to assist clinicians with capturing and analyzing population‐based data to support practices with data‐driven decision making and direct improvement efforts to support practice leadership develop the skills to interpret and act on quality metric data with performance management tactics.
  • Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
  • Builds trusting relationships to help drive continuous change with physicians/physician staff to find ways to encourage member clinical participation in wellness and education by providing resources and educational opportunities to provider and staff.
  • Prepare practices to continue the transformative activities that demonstrate consistent improvement on performance and quality measures.
  • Develop and implement changes to root causes of financial and quality under performance and communicate strategies to providers and provider groups.
  • Understand the role of analytics and the importance of clear, defined, and accurate data for improving healthcare outcomes.
  • Execute responsibilities in a manner that promotes collegial, collaborative, and effective communication to successfully reach mutually agreed upon goals with practice sites and colleagues.
  • Provide support for other interdisciplinary teams (e.g. s clinical implementation, analysis, research, support services, training, medical record retrieval projects).

ESSENTIAL DUTIES:

1. Provide customized coaching at clinical sites (e.g. PCP, Specialist Practice, Clinical networks) by working with the sites to identify site‐specific needs and opportunities, prioritizing areas of focus, and identifying available and needed resources.