Performance Liaison - Fall River, MA
The Performance Liaison works in collaboration with physician practices with opportunities for improved quality, risk adjustment, clinical and documentation workflow, patient experience and performance.
Essential Duties and Primary Accountabilities:
• Works in collaboration with provider offices to target opportunities for improved quality, risk adjustment, clinical and documentation workflow, patient experience and performance.
• Maintains 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.
• Evaluates provider and office staff workflow to identify opportunities for workflow improvement and is responsible for developing and implementing process improvement to enhance provider and staff workflow.
• Completes medical record data review/collection for appeals and exclusions at the time of data submission per contractual obligations.
• 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.
• Interacts with and provides providers and office staff best practices and workflows regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Responsible for monitoring provider performance and reporting to SHCN management to track and share data with practice on performance against goals, escalating any issues at the practice level in a timely manner.
• Report on quality measures and evaluate strengths and weaknesses and address workflow deficiencies.
• Works collaboratively with assigned Performance staff, Office Managers, and practice staff to coordinate improvement efforts related to overall performance.
• Implements performance improvement plans at the practice level.
• Produces and maintains record by keeping documentation up to date and reporting progress on a weekly basis.
• Provides dashboard reports to providers and practices and recommendations on improvement.
• Educates providers and leadership on clinical indicators to capture the severity of illness of the patient.
• Develops and delivers training materials (Provider and Practice-Facing).
• Provides leadership and staff with training, on-site collaboration and on-going performance reporting.
Education / Experience / Other Requirements
• Medical Assistant of LPN license preferred, or equivalent clinical experience
Work Related Experience:
• 2-3 years of physician practice experience preferred
• Knowledge of quality metrics and risk adjustment preferred
Physical and Mental Demands
These physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Required to attend meetings as necessary at local chapter and SHCN central offices.
• Ability to project manage and work with multiple priorities
• Ability to organize and prepare training materials, conduct in person and computer-based training
• Ability to use technology effectively with basic Microsoft product proficiency.
• Ability to work under pressure and demonstrate a strong sense of diplomacy and
• Ability to work independently with excellent written and oral communication skills, organization skills, and attention to detail.
• Ability to demonstrate strong interpersonal and communication skills; able to effectuate areas of opportunity to providers and practices as well as leadership.
Job Status: Full Time
Job Reference #: 2070