RN Population Health Risk Adjustment

Job Description: • Serves as a subject matter expert in support of Risk Adjustment Factor (RAF) tools for Banner Medical Group. • Coordinates the business design, testing and implementation of web-based RAF tools and reports in areas of expertise. • Monitors and ensures tools are available post implementation. • Responsible for the development and implementation of Risk Adjustment education and training for network physicians and practices, including documentation and coding requirements, HCCs, HEDIS quality ratings. • Establishes and promotes a collaborative relationship with physicians, third party vendors, and other members of the health care team. • Collects and communicates pertinent, timely clinical information to third party vendors and others to fulfill utilization and regulatory requirements. • Assess accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately. • Partners with Risk Adjustment resources to provide guidance on utilization of Risk Adjustment tools. • Provides formal training and supports physicians and practices in the day to day utilization of Risk Adjustment tools throughout Banner Medical Group. Requirements: • Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience. • Must possess a current, valid RN license in the state of practice. • Must demonstrate effective relationship development skills, and ability to effectively communicate in individual and group settings. • Teamwork is critical. • Attentive listening and polished presentation skills are needed to effectively educate providers and practices on Risk Adjustment tools. • Requires critical thinking and project management capabilities. • Position requires proficiency in personal software applications, including word processing, generating spreadsheets, claims adjudication and provider systems. Benefits: • Health care is changing, and it’s our goal to create a new model to answer America's health care challenges today and in the future. • Skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. Apply tot his job