Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Leads a team providing guidance on risk assessment methodologies.
Partner with tech-product-analytic teams to design and maintain sophisticated risk algorithms.
Develop a roadmap that defines the path to operationalize specific actions.
Aledade empowers independent primary care as the largest network in the country. They help practices, health centers, and clinics deliver better care to their patients and thrive in value-based care with a collaborative, inclusive, and remote-first culture.
Design, execute, and ensure operational excellence of risk adjustment coding and clinical documentation programs.
Create scalable, physician-centric educational programs for accurate and complete diagnosis documentation.
Lead a multidisciplinary team of coders, auditors, and analysts to ensure operational excellence and talent development.
Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. They're the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care.