Description The healthcare system isn't designed for health. We're designed to change that. We're Wellvana, and we help doctors deliver life-changing healthcare. Through our elevated value-based care programs, we're revitalizing an antiquated system that's far too long relied on misaligned incentives that reward quantity of care not the quality of it. Our enlightened approach-covering everything from care coordination to clinical documentation education to marketing- ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors. Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing. Named a 2024 Best in Business and 2023 Best Place to Work by Nashville Business Journal , we're one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be. Clarity on the Role:The Director of Provider Education is a key leadership position responsible for overseeing and optimizing risk adjustment programs while ensuring high-quality education and training for all affiliated providers, practices and health system partners. This role involves strategic planning, risk assessment, educational program development, and compliance management. What's Expected: Risk Adjustment Strategy:
- Develop and implement a comprehensive risk adjustment strategy in alignment with the organization and partner's goals and objectives.
- Oversee risk assessment processes to accurately capture, document and inform practices regarding patient acuity and severity for appropriate reimbursement.
Educational Program Management:
- Design, implement, and manage educational programs aimed at improving the coding, documentation, and quality of care provided by affiliated providers and partners.
- Collaborate with subject matter experts to create relevant curriculum and training materials.
Compliance and Regulatory Oversight:
- Ensure compliance with all relevant healthcare regulations, including CMS guidelines for risk adjustment.
- Stay updated on changes in regulations and adjust strategies and programs accordingly.
Team Leadership:
- Recruit, mentor, and lead a team of professionals responsible for risk adjustment and quality education initiatives.
- Hold the team and self accountable to key performance and productivity metrics and results.
- Foster a culture of continuous learning and improvement within the team.
Data Analysis and Reporting:
- Utilize data analytics and reporting tools to assess risk adjustment performance, identify opportunities for improvement, and monitor outcomes.
- Provide regular reports to senior leadership and stakeholders regarding productivity and performance metrics, team results and impact
Collaboration and Stakeholder Engagement:
- Collaborate with healthcare providers, payers, and internal departments to ensure accurate risk capture and reporting.
- Engage with key stakeholders to align risk adjustment and quality education initiatives with organizational goals.
- Strategize with the field team on engagement tactics and relationship-building processes for educators to engage with practices in assigned regions
Quality Assurance:
- Implement quality assurance processes to monitor the effectiveness of educational programs and risk adjustment efforts.
- Monitor and evaluate the impact of risk adjustment strategies on revenue optimization.
Training and Development:
- Organize and conduct training sessions, workshops, and seminars for healthcare providers and staff to improve coding accuracy and documentation practices.
Continuous Improvement:
- Identify areas for improvement in risk adjustment and quality education programs and implement changes to drive better outcomes.
- Encourage innovation and the adoption of best practices.
Requirements
- Integrity: The right way is the only way.
- Dependability: You do what you say you're going to do.
- Advocacy: You fight for the best possible outcome for providers and their patients.
- Clarity: You make it all understandable.
Education (Degree/Major):
- A master's degree or higher in healthcare administration, healthcare management, or a related field.
Certifications:
Years of Related Experience:
- 10+ years of experience in Medical Coding, Auditing and Education
Skills:
- Significant experience in risk adjustment, revenue cycle management, or healthcare quality improvement.
- Strong knowledge of healthcare regulations, particularly risk adjustment and related provisions.
- Experience with provider educational program development and delivery.
- Excellent leadership and team management skills. Demonstrated ability to manage a team and hold all team members accountable to deliver results
- High experience and proficiency in Microsoft office solutions: Excel, Word, Powerpoint, etc
- Proficiency in data analysis and reporting.
- Effective communication and interpersonal abilities.
- A commitment to continuous learning and staying updated on industry trends.