Steward Health Care Network
Steward Health Care Network
This position reports to the Clinical Liaison Supervisor and Manager of Risk Adjustment for the Steward Health Care Network. As a member of the Practice Performance Improvement team, the Clinical Specialist works in collaboration with physician practices with opportunities for improved quality, risk adjustment and clinical workflow (referral management and population health management) performance. The Clinical Specialist is a valuable resource to practices for improving quality and risk adjustment by providing practice leadership and staff with training, on-site collaboration and on-going performance reporting. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.
Work collaboratively with assigned Performance and local chapter staff, Office Managers, and practice staff to coordinate improvement efforts related to overall performance. Implementation of performance improvement plans at the practice level.
* Assists in preparation of training materials (Provider and Practice-Facing).
* Provides on-site education and guidance.
* Provides dashboard reports to providers and practices and recommendations on improvement.
* Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures
* Documentation and Coding Review
o Reviews for clinical indicators and query providers to capture the severity of illness of the patient.
o Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
* Provides SHCN PHS and practice staff with appropriate level of clinical training relative to performance measures including but not limited to spirometry, ABIs, taking and recording a blood pressure, urine collection and diabetes in-office testing.
* Works with SHCN Patient Registry and practice Electronic Health Record or paper record to support SHCN reporting and monitoring of quality performance.
* Works with assigned practices as appropriate and agreed upon to engage patients which may include but not limited to:
o Directly engaging patients to ensure screening and other required preventative tests and appointments are completed.
o Working with laboratory and other vendors as required to collect patient results.
o Participate in office/practice team huddles as appropriate
o Support process improvement to enhance physician and staff workflow
o Support medical record data review/collection for appeals and exclusions at the time of data submission per contractual obligations.
* Produces and maintains record by keeping database up to date and reporting progress on a weekly basis and to determine impact of interventions.
* Maintain collaborative team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment.
* Coordinate with SHCN management to track and share data with practice on performance against goals.
* Performs other similar and related duties as required or directed.
REQUIRED KNOWLEDGE & SKILLS:
* Clinical background (MA or LPN) with coding (HCC/MRA) experience preferred.
* Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
* Strong interpersonal and communication skills: able to effectuate areas of opportunity to providers and practices as well as leadership.
* Ability to use technology effectively with basic Microsoft excel proficiency.
* HCC coder will be using a dashboard tool to analyze and generate reports.
* Strong sense of diplomacy and ability to work under pressure.
Required to attend meetings as necessary at local chapter and SHCN central offices.
I. Education: Medical Assistant certification or LPN license.
II. Experience (Type & Length): 2-3 years of physician practice medical assistant or LPN license support preferred. Experience in quality and risk adjustment preferred.
Job Reference #: 100023549