RN - Risk Adjustment Provider Educator

April 15

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

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Wellvana

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Wellvana is a company focused on transforming primary care through value-based care models. They provide essential support to independent physicians and health systems, helping them navigate the challenges associated with transitioning from fee-for-service to value-based payment structures. Wellvana emphasizes a personalized approach, offering data-driven insights and a range of wraparound services designed to improve patient outcomes and reduce healthcare costs. Their aim is to empower healthcare providers to thrive in the evolving landscape of primary care.

Value-based care • care management • health tech

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

💰 $84M Series B on 2023-03

📋 Description

• 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.

🎯 Requirements

• Bachelor’s degree preferred • Registered Nurse with unrestricted license to practice in the state of Texas • CRC & CPC required • CPMA preferred • 5+ years of experience in risk adjustment coding and documentation improvement queries • Minimum 3+ years clinical practice experience • 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

🏖️ Benefits

• 2024 "Best in Business" • 2023 "Best Place to Work" by Nashville Business Journal