| The ACO Quality Nurse/ Market Lead will be responsible for engaging directly with ACO and CIN primary care practices to provide education, reports and tools that support improved coding documentation, patient engagement and key quality performance indicators. Growth for our networks will increasingly be driven by Medicare Advantage, Medicare ACO, Exchange and other any other programs that require providers to execute on initiatives that support the correct risk of an aligned patient population. As such, Tenet�s ACO/CIN success will be dependent on improving these quality functions and directly supporting the related educational needs for our network practices. Further, the quality nurse will also be responsible for reporting and tracking on program performance, identifying and implementing critical program strategies and for organizing/leading advancement strategies to enhance engagement of member practices. The position will more specifically be responsible for the following:
- Functioning independently, travel within the market to meet with assigned providers to discuss Tenet ACO tools and programs focused on improving the quality of care for Medicare and Exchange members, as well as other programs where applicable
- Assists with recruitment and onboarding initiatives for new network practices
- Improve practice accountability for meeting network quality metrics by being present in the practices 70-80% of time with rare occasion of overnight travel
- Utilizing Tenet and Conifer tools, identify and prioritize providers who would benefit from coding, documentation and quality training and resources
- Establish positive, long-term, relationships with physicians, practice managers and practice clinical teams
- Develop, monitor and promote compliance with provider-specific targets that improve coding and documentation accuracy
- Develop a standard Health Risk Assessment Form and other screening forms that promote early disease detection and capture accurate diagnoses documentation in support of accurate provider payments, and billing and encounter data to contracted payers
- Educate practice on gap in care needs network quality measures and related portal reporting
- Assess EMR/EHR barriers where it is causing issues in meeting CMS standards of documentation and coding
- Partner with other ACO department leaders to develop and implement ongoing tools and materials that support quality improvement and the importance of proper chart documentation of procedures and diagnosis coding
- Assist practices in understanding network quality metrics and ongoing practice performance
- Educate practice teams by auditing documentation to ensure it supports the submission of relevant and accurate ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
- Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
- Develops and presents coding presentations and training to ACO/CIN boards, large and small groups of clinicians, practice managers and certified coders, adjusting and developing training to fit specific provider's needs
- Periodically audit provider chart documentation for compliance with CMS and other regulatory requirements related to risk-adjustment documentation and accuracy
- Trains physicians and other staff regarding best practices in documentation, billing and coding and provides feedback to physicians
- Provides actionable solutions to providers, including practice workflow suggestions, that will result in improved accuracy for documentation and coding practices
- Collaborates with Tenet Physician Resources, Tenet case management and applicable facility staff on risk adjustment and quality education efforts
Qualifications:
- Nursing background, with active credentials preferred(i.e., LPN, RN, NP, CMA)
- Bachelor�s degree in Health Care or related field, or the equivalent combination of education and/or experience.
- 4+ years of provider, health plan or hospital experience
- Certified Professional Coder / CPC-A; CRC certification; CCS, RHIA, or willing to obtain coding certification within 6 months
- Working knowledge of ICD-10, clinical standards of care, preventive health and quality standards (e.g. HEDIS), hierarchical condition categories (HCCs) and risk adjustment methodologies
- Excellent analytical abilities - proficiency in MS Office and Excel
- Must be able to work effectively with common office software, coding software and EMR systems
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Job: Nursing Primary Location: Birmingham, Alabama Facility: Birmingham Market Office Job Type: Full-time Shift Type: Days
Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. |
