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Fort Collins, Colorado, United States
Hybrid
Primary City/State:
Fort Collins, ColoradoDepartment Name:
WR Admin-Region-ClinicWork Shift:
DayJob Category:
NursingThe future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.
Great options and opportunities. We’re certified as a Great Place To Work® and are looking for professionals to help us make Banner Health the best place to work and receive care. Apply today!
As an RN for Population Health, you will have the opportunity to support our Northern Colorado patient population and physicians by completing thorough chart reviews and assisting providers prior to a patients initial visit, for their medical records and coding.
The preferred candidate this role will be located in Norther Colorado to support on-site requirements, when needed.*
Shift Details:
-Monday - Friday, 8 hour shifts, with some flexibility following orientation
Location:
-Will primarily work remote in Northern Colorado.*
-Must have reliable internet (NO WIFI, Ethernet Connection only) and a quiet work area/home office.
If interested, apply today!
If you are a New Graduate Nurse with less than 12 months of experience, please visit the main job search page, and under the Job Type Filter, select New Nurse Experience.
*Recruiter will go over details of the schedule and location during the interview.
At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.POSITION SUMMARY
This position provides clinical and operational coordination of all Risk Adjustment efforts in support of achieving organizational strategic initiatives related to the organization’s Risk Adjustment program goals. This position is also responsible for understanding and serving as an informative source on Medicare Advantage funding models (Risk adjustment, HCCs, HEDIS quality Rate, etc.) This includes collaborating with key stakeholders to implement the activities across BMG and to identify opportunities for optimization of RAF scores and capture of Hierarchical Condition Categories (HCCs).
CORE FUNCTIONS
1. 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.
2. 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.
3. Assess accuracy and comprehensiveness of HCC recapture to ensure that diagnosis opportunities are identified timely and appropriately, with a goal to optimize the program’s financial benefit to Banner Health.
4. 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.
5. Serves as primary contact with external physicians and practices for escalated issue resolution related to Banner RAF tools. Identifies trends and escalates issues as required to ensure proper resource management, customer satisfaction and issue resolution. Develops and implements recommendations to improve business processes to support and/or optimize RAF scores. Works collaboratively with ambulatory care management to ensure quality performance criteria expectations are disseminated so physicians and practices are equipped to meet and/or exceed clinical targets.
6. Accesses and interprets data from a variety of sources to gain full understanding of Risk Adjustment trends and educational opportunities. Meets regularly with BMG workforce team to review findings and develop an improvement plan to meet organizational goals. Partners with Risk Adjustment Quality Analysts and Educators to develop educational materials. Meets regularly with workforce teams to support communication and promote partnership.
7. Participates in or leads Risk Adjustment projects designed to improve program offerings or address system limitations. This may include analysis of BMG Practice Management systems, clearinghouse routing, vendor routing and/or CMS submissions.
8. Monitors data submission for attestation to CMS for Risk Adjustment. This position also analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance. Reviews, prepares, analyzes, and presents reports and as needed.
9. This subject matter expert role will interface on a regular basis with all levels at assigned facilities/entities. This position will also interact with both internal resources and external vendors.
MINIMUM QUALIFICATIONS
This position requires graduation from an accredited nursing program, including an Associate's, Bachelor's, or Master's degree in Nursing, or the completion of a specialized nursing diploma program that includes at least two years of specialized training and/or experience. Must possess a current, valid RN license in state of practice, temporary/interim RN license in state of practice, or compact RN licensure for current state of practice. BLS certification is required.
Must possess a current, valid RN license in the state of practice.
Must possess a strong knowledge of healthcare provider relations as normally obtained through 3-5 years of related healthcare experience. 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.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Estimated Pay Range:
$36.14 - $60.23 / hour

Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

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