RN Provider Educator

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Job description

Description The Why Behind Wellvana: The healthcare system isn't designed for health. We're designed to change that. We're Wellvana, and we help doctors deliver life-changing healthcare. Through our elevated value-based care programs, we're revitalizing an antiquated system that's far too long relied on misaligned incentives that reward quantity of care not the quality of it. Our enlightened approach-covering everything from care coordination to clinical documentation education to marketing- ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors. Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing. Named a 2024 "Best in Business" and 2023 "Best Place to Work" by Nashville Business Journal, we're one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be. Clarity on the Role: The RN Provider Educator partners with Wellvana affiliated practices and health systems on all aspects of risk adjustment coding, regulatory requirements, and proper documentation procedures for attributed patients in Medicare Advantage, MSSP, and ACO Reach programs. The RN Provider Educator will be responsible for reviewing clinical data and available patient documentation to confirm patient diagnoses in advance of in office physician visits. Key to this process is personalizing individual physician and practice feedback and to Identify coding trends and documentation patterns from data retrieved by coding reviews and audits. The RN Provider Educator must have a thorough understanding of the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy and be able to communicate this knowledge effectively to physicians and their practice leaders. Maintaining a comprehensive schedule and visit log is crucial as is the documentation, and storage, of all materials utilized in practice and health system discussions. The RN Provider Educator is responsible for building positive relationships with assigned Physicians and serves as a key point of contact for any questions or concerns that may arise. What's Expected: Industry Knowledge Thorough understanding of the industry rules and regulations and particularly the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy, open condition reporting, identifying unreported conditions, readdressing open chronic conditions Demonstrated ability to communicate this knowledge effectively to physicians and their practice leaders. Expertise in Prospective, Retrospective, and Concurrent review processes Organization and Initiative Effectively coordinate and schedule visits with practices, prepare and distribute practice specific materials timely (e.g., minimum of 48 business hours in advance), conduct education sessions, document follow-ups, and store corresponding materials in central repository Identify any error trends in provider clinical documentation and coding by analyzing data derived from coding reviews and internal audits results. Construct training materials utilizing internal standards and insights from respective practice data sets and reviews. Consult with providers and billing staff to correct errors found. Escalate to leadership if practices do not respond accordingly to meeting requests or follow-ups, or if practice is not adhering to clinical documentation and risk adjustment guidelines Attention to detail to maintain a practice schedule, visit and travel log to document and track all practice outreach, engagement and to organize and file specific materials utilized in education sessions Distribute company provided educational materials and coding tools to guide providers to utilize Wellvana technology and solutions to manage their clinical documentation activities. Complete practice, or function, special projects as assigned by leadership Practice Relationship Management Build and maintain professional relationships with providers and their staff within assigned region, performing monthly in person, or virtual, visits to assigned offices depending on practice size, location and practice's demonstrated understanding of clinical documentation guidelines. Ability to collaborate with practices to review patient medical records on a timely basis in advance of upcoming patient visits. Monitor Prospective and Concurrent workflow adoption and identify and correct any potential issues or problems. Ensure practice is executing timely submission of coding corrections as needed Collaborate with internal team members including Provider Account management, risk adjustment and audit teams regarding all provider specific educations and noted action items. Follow up on items as identified with practices and coordination with internal team members and practice partners to ensure completion. Achievement and Performance Consistently meet/exceed all internal performance metrics: practice visits and cadence targets (e.g., monthly meetings), distribution of materials minimum of 48 hours in advance of sessions, timely storage of all education materials (within 24 hours of visit) Responsible for distributing all claims corrections as identified and provider documentation queries. Perform post audits on any action items to assure compliance Track improvements in provider coding Quality scores resulting from ongoing educations Complete submission of all required reports and productivity metrics within prescribed timelines. Compliance Ensure compliance with all relevant healthcare regulations, including CMS guidelines for clinical documentation and quality initiatives. Stay apprised and complete necessary training on changes in regulations and adjust strategies and programs as needed. Adhere to all clinical documentation and risk adjustment rules and regulations and to Wellvana designed frameworks and technology solutions in every provider education session. Continuous Improvement: Identify areas for improvement in clinical documentation and quality education programs and elevate to leadership for evaluation. Consistently adopt and implement best practices as assigned. Requirements Integrity: The right way is the only way. Dependability: You do what you say you're going to do. Advocacy: You fight for the best possible outcome for providers and their patients. Clarity: You make it all understandable. Education (Degree/Major): Bachelor's degree preferred Certifications: Registered Nurse with unrestricted license to practice in the state of Texas CRC & CPC required CPMA preferred Years of Related Experience: 5+ years of experience in risk adjustment coding and documentation improvement queries Minimum 3+ years clinical practice experience Skills: Strong knowledge of healthcare regulations, particularly risk adjustment, quality and related provisions (Risk Adjustment Coding, CMS-HCC Hierarchy Model coding, Industry Rules and Regulations). Ability to identify any potential areas of Fraud and Abuse regarding coding and documentation, according to regulatory agency guidelines Ability to conduct comprehensive chart reviews as needed. Experience closing quality care gaps. Experience with provider education programs and delivery. Ability to communicate effectively to providers in individual and group settings Demonstrated aptitude towards problem identification, comprehension and resolution. Demonstrated analytical and problem solving skills. Proficiency in data analysis and reporting. Strong attention to detail and proven ability to meet deadlines and performance targets. Solid experience and proficiency with Microsoft Office tools (Excel, Powerpoint, Word, Outlook, etc) Ability to quickly learn and leverage internal reporting and proprietary toolsets to manage individual productivity and performance Effective communication and interpersonal skills. A commitment to continuous learning and staying updated on industry trends. Ability to travel frequently as Provider Educator will be required to travel to provider clinic locations; includes reliable transportation to conduct in person interactions with local Providers.

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