Job Description


Support: Works in collaboration with physician practices 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. Supports process improvement to enhance physician and staff workflow. Supports 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



Performance: Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. Coordinates and communicates with SHCN management to track and share data with practice on performance against goals, escalating any issues at the practice level in a timely manner. 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.



Reporting: 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.



Coaching: Educates providers and leadership on clinical indicators to capture the severity of illness of the patient. Assists in preparation of 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.

Specialized Knowledge:  

·         Knowledge of quality metrics and risk adjustment preferred.


Application Instructions

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