Risk Adjustment Revenue Cycle Analysis and Solutions

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 role delivers specialized expertise to Capstone’s clients by actively assessing and monitoring the Medicare revenue cycle for PACE programs. Acting as a strategic partner, the Client Service Liaison collaborates closely with PACE program financial teams to interpret Medicare payment data, identify variances or risks, and support accurate and timely premium payments in the Medicare revenue cycle for PACE programs.

Responsibilities

• Completes assessment for assigned panel of PACE programs using CMS returns files and input from all Capstone departments' analytics, including but not limited to coding, auditing, and medical consultants.

• Assess the client's needed action plan based on structured assessments every quarter, including on-site client visits, virtual conference calls, etc.

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

• Works with the 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 as needed. 

• Provides support and collaborates with other Capstone teams in relation to the assigned client panel.

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

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

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

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

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

• 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. 

Education

• Required:  Associate Degree

• Preferred:  B.S, B.A., or B.S.N

Experience

• Required:

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

  • Experience with Risk Adjustment Analytics strongly preferred

• Preferred:

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

  • Knowledge of CMS Medicare revenue cycle in the risk adjustment payment model

Skills & Abilities

• Proficient with MS Word, Excel, and 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:  This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within the assigned territory. May be necessary to work extended hours as needed. 

Schedule:  This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. 

This is a remote position.

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.