Risk Adjustment Data Entry (On-Site)

General Summary: This role focuses on the improved documentation of acuity for the capitated GMG patient population through the Review Medical History process, Intake visits and other outreach efforts.  Also helps with other Managed Care projects.
    
Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements: All duties performed will be done accurately and in a timely manner. 

1.    Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
2.    Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
3.    Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication. 
4.    Participates in other Managed care projects to include but not limited to marketing events, and Medicare Open enrollment period. 
5.    Reviews reports to identify areas for improvement or needed action to meet departmental goals.
6.    Supports team members in all aspects of the Risk Adjustment process to ensure that defined timelines and departmental goals are met.
7.    Adhere to all confidentiality and HIPAA requirements as always outlined within Gonzaba Medical Group Operating Policies and Procedures in all ways and with respect to any aspect of the data handled or services rendered.
8.    Other duties as assigned.
    
Essential Job Responsibilities:    
1.    Maintain accurate database of GMG capitated patients, update database monthly from enrollment and disenrollment reports.
2.    Accurately update the database to track each stage of the RMH process.  This is vital to an effective process and accurate reports.
3.    Prepare audit documents as defined; create logical batches for reviewers.
4.    Process completed audits for timely data entry into EMR.
5.    Assist with teaching clinical staff how to identify patients needing RMH review, preparing RMH notes for the provider, and processing RMH encounter notes; also teach how and when to schedule future RMH appointments.
6.    Keep PCP, clinical staff and Managed Care team members informed of pertinent findings/issues uncovered.
7.    Track & report completed RMH DOS for CMS submission.
 

Work Environment: Clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
    
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 15 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
    
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
    
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position.  Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor.  Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
 

Education and Training: Minimum high school education or equivalent. Medical Assistant Certificate or Current TX LVN license preferred.  CPR with AED certification preferred. 

Experience: Experience in a clinic, doctor’s office or hospital with a minimum of one-year experience preferred.  
    
Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.