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Value-Based Care / RCM Quality Analyst

Non-Providers Careers
Full-time
On-site
Annapolis, Maryland, United States

The Value Based Care / RCM Quality Analyst leads and manages the organization�s value-based care initiatives. This includes collaborating with the leadership team to select VBC programs and vendors and monitoring organizational performance. This position also assists the RCM team with quality and coding analysis.

Essential Duties and Responsibilities:

  • Performs job in accordance with Company Mission, Vision and goals.
  • Develops and leads the overall strategy for value-based care initiatives
  • Advises the leadership team on value-based care strategies.
  • Manages the organization's value-based care activities.
  • Manages the relationships with value-based care vendors.
  • Analyzes the potential revenue implications of various value-based care strategies. Collaborates with company leadership to ensure that value-based care initiatives meet financial performance targets and contribute to the organization�s financial sustainability.
  • Monitors and evaluates the performance of value-based care initiatives and implement necessary adjustments in partnership with operational and clinical leadership to achieve desired results.
  • Utilizes data analytics to monitor and improve performance.
  • Provides provider and staff education on value-based care and quality management expectations.
  • Ensures compliance with all regulatory reporting requirements.
  • Examines claims for compliance with relevant coding, billing, and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
  • Collaborates with the Compliance and Auditing teams to support providers and RCM functions.
  • Collaborates with the Revenue Cycle Team and other internal areas on matters of mutual concern.
  • Recommends possible interventions for loss control and risk avoidance.
  • Checks and responds to work e-mail on a regular basis throughout the workday.
  • Participate in and complete all required trainings and in-services.
  • Performs other duties as assigned.

Minimum Qualifications:

  • Bachelor�s Degree from and accredited college or university with four (4) years of medical coding/auditing experience and prior experience in value-based care, OR an equivalent combination of education and related experience.
  • Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
  • Must have prior experience utilizing PowerBI or a similar data analytics software.
  • Must have excellent written and oral communication skills, including exceptional customer service.
  • Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
  • Must be able to work individually as well as within a team.
  • Must be able to follow both verbal and written instructions.
  • Must be able to work a flexible schedule.
  • Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
  • Must be able to multi-task and prioritize.
  • Must demonstrate extreme attention to detail.
  • Must possess strong organization skills.
  • Must be able to problem solve and use reasoning.
  • Must be able to meet predefined quality standards.
  • Must maintain and project a professional attitude and appearance at all time.
  • Must have a working knowledge of CPT and ICD-10 coding rules.
  • Must have a solid foundation of insurance knowledge and guidelines for third party payers.
  • Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
  • All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

  • Three (3) years� experience working with an Electronic Medical Record (EMR).
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA).
  • Experience and/or training in project coordination.

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee�s home, work assignments could be in any of the Company�s locations.

Compensation and Benefits:

  • Pay Range: $110,000/year - $130,000/year
  • PTO: Up to 96 hours in first year (pro-rated based on start date)
  • Holidays: 7 (New Year�s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
  • Retirement: 401(k) with employer match
  • Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
  • Other Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
  • Other Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity
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