Risk Adjustment Revenue Cycle Analyst

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

This position performs highly technical and specialized functions for Capstone.  In addition to reviewing & analyzing coding related data, the Client Services Liaison also coordinates the “care” of the client.  The primary function of this position is to promote retention, growth, and satisfaction through coordinated communication with the client. 

Responsibilities

• Completes quarterly assessment for assigned panel with input from all Capstone departments, including but not limited to coding, auditing, & quality assurance.

• Assesses client needs based on structured assessments every quarter. Coordinates all Capstone services to the clients in the assigned panel via quarterly plans including client visits, conference calls, surveys, etc.

• Develops and strengthens Capstone client relationships in defined assignment panel.

• Works with Capstone project coordinator to ensure successful new client onboarding.

• Monitor client needs and recommend additional services and/or improvements to current services, when appropriate.

• Responsible for ensuring customer satisfaction by resolving issues quickly and creatively.

• Assist the client with navigating and optimizing the use of service offerings and reports.

• Provide and/or coordinate additional training and education to the clients (other than quarterly review) via webinar.  Including additional audit reviews, CPS reports, CDI, etc. as identified.

• Provides support and assistance to other Capstone teams in relationship to assigned client panel.

• Develops and maintains master schedules for all clients in assigned client panel.

• Participates in internal collaboration calls regarding clients in assigned client panel.

• Maintains professional license and certifications (where applicable) and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.

• Performs other functions as required.

• Understands and adheres to The Health Insurance Portability and Accountability Act (HIPPA) requirements.

• Participates as requested in department meetings, client calls, and annual performance evaluation.

• Performs other duties and responsibilities as required.

• Completes miscellaneous projects for Capstone as assigned or requested.

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts, or working conditions associated with the position.  While this description is intended to be an accurate reflection of the current position, management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (e.g., emergencies, change in personnel, workload, rush jobs, or technological developments).

Qualifications

These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• Required:  Associate Degree

• Preferred:  B.S, B.A., or B.S.N

• Required:

  • Minimum three years of experience providing clinical documentation Improvement training.

  • Minimum three years of experience in Hierarchical Condition Categories (HCC) or risk adjustment.

• Preferred:

  • Knowledge of or experience in Risk Adjusted contracting or provider groups.

  • Experience with Risk Adjustment Analytics strongly preferred.

Skills & Abilities

• Proficient with MS Word, Excel, PowerPoint, and Comfortable with learning and becoming an expert on new and proprietary software.

• Highly skilled in written and verbal communication.

• Highly skilled at establishing priorities and coordinating work activities.

• Excellent presentation skills

• Skilled at performing multiple and complex tasks.

• Have exceptional initiative and follow-through on projects with minimal supervision or guidance.

• Must be detail oriented, follow instructions, and work independently with minimal supervision with highly confidential information per HIPAA regulations.

• Comfortable working in a fast paced, rapidly changing environment.

Physical & Mental Demands

Requires manual and finger dexterity and eye-hand coordination to use computer and office equipment and the ability to lift/carry up to 30 pounds using appropriate body mechanics. Must be able to sit for extended periods of time at a computer. Must be able to communicate verbally and in writing. Must be able to handle a multitude of projects simultaneously, work well under pressure, meet deadlines and maintain confidential and sensitive information. Must be an independent thinker who is willing to take on extra responsibility and work independently with little supervision.  Must be able to work well with others, at many levels and of many backgrounds.

Schedule

This is a remote position.  Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.  

AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.