Bon Secours

Lead and coordinate risk score accuracy initiatives including HCC coding, collaborate with stakeholders to optimize value-based contract success, and provide training and compliance oversight in medical coding. | Requires 5+ years in risk score accuracy or quality outcomes in healthcare, Certified Professional Coder (or equivalent) within one year, knowledge of ICD-10-CM and HCC coding, and preferably Epic EHR experience. | With a legacy that spans over 150 years, Bon Secours is a network that is dedicated to providing excellent care through exceptional people. At every level, everyone on our teams have embraced the call to provide compassionate care. Here, you can work with others who share common values, and use your skills to help extend care to all of our communities. Primary Function/General Purpose Of Position The Risk Score Accuracy (RSA) Program Manager provides leadership, oversight, coordination, and subject matter expertise for insights related to Population Health Clinical Integration RSA initiatives, including Hierarchical Condition Categories (HCC) coding and other risk adjustment payment models. This role strategizes and collaborates with key stakeholders across the Ministry, including Bon Secours Mercy Health (BSMH) Population Health, Compliance and Revenue Cycle teams, Ensemble, and BSMH physicians and advance care clinicians, to achieve system-wide success in value-based contracts. • This is a remote/work from home position. Hire must be open to working eastern time zone hours. Essential Job Functions • Oversees prospective, concurrent, and retrospective chart reviews for diagnosis coding accuracy leading to value-based contract success through compliant coding and documentation. • Supports payer relationships by coordinating chronic condition recapture and suspect condition validation processes and recording HCC suspect validation responses in payer portals. Collaborates with plan representatives to obtain and analyze RSA gap data. Tracks payer-specific RSA performance to share with providers and leadership. Facilitates responses to payer-focused HCC validation requests and communicates missed HCC trends to System Director of RSA for dissemination to clinical leadership. Monitors payer suspect algorithms for potential internal HCC build improvements. • Partners with BSMH Compliance to deliver accurate HCC coding instruction as part of ambulatory provider training and onboarding, ensuring compliance with federal and state coding regulations. • Identifies opportunities for performance improvement related to system-wide HCC and other risk adjustment coding initiatives. Conducts medical record reviews and analyzes internal data to identify opportunities for real-time training intervention related to International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding and risk adjustment scores. • Coordinates and participates in collaborative coding forums with BSMH coders and Revenue Cycle team, BSMH Compliance and Internal Audit teams, Ensemble coding and billing leaders, BSMH leaders, and Population Health team to share best practices and optimize resources. • Communicates provider coding accuracy concerns and challenges to System and Local Market leadership, delivers or participates in education sessions, and attends coding leadership meetings as requested. Develops HCC and ICD-10-CM coding tools and references. • Monitors trends for patient populations in value-based contracts and provides feedback to providers and appropriate Ministry leadership to ensure diagnosis coding accuracy and supportive documentation for reduction in compliance risks and costs, as well as appropriate reimbursement based on complexity of patient care. • Maintains knowledge of professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions within the health system. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation. Licensing/Certification Certified Professional Coder (CPC) or equivalent, (preferred at time of hire, required within one year of hire) Certified Risk Coder (or equivalent), Licensed Practical Nurse or other clinical certification (preferred) Education Bachelor’s Degree (preferred) Work Experience 5 years of experience progressive responsibility, with risk score accuracy or quality outcomes experience, with a payer or in a healthcare system (required) Training Epic Electronic Health Record (preferred) Language None Patient Population Not applicable to this position Working Conditions Periods of high stress and fluctuating workloads may occur. Long-distance or air travel as needed- not to exceed 10% travel. General office environment. Required to car travel to off-site locations, occasionally in adverse weather conditions. Skills Risk Score Accuracy Program Management Medical Terminology CPT Data Validation Hierarchical Condition Categories ICD-10-CM Payer Relationships Medical Coding Data Collection Analytical Skills Trend Analysis Communication Communication with all levels Collaboration Attention to Detail Process Improvement Stakeholders Managing Multiple Priorities Time Management Many of our opportunities reward* your hard work with: Comprehensive, affordable medical, dental and vision plans Prescription drug coverage Flexible spending accounts Life insurance w/AD&D Employer contributions to retirement savings plan when eligible Paid time off Educational Assistance And much more • Benefits offerings vary according to employment status All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com

Develop and implement compliance audit protocols and monitors for hospital revenue cycle services, analyze claims and billing data to detect fraud or abuse, and support corrective action plans and compliance education. | Requires 2-4 years healthcare auditing or coding experience, certifications such as CCS, CPC, RHIT, or RHIA, knowledge of Medicare/Medicaid and OIG/CMS regulations, and preferably experience with EPIC EMR. | With a legacy that spans over 150 years, Bon Secours is a network that is dedicated to providing excellent care through exceptional people. At every level, everyone on our teams have embraced the call to provide compassionate care. Here, you can work with others who share common values, and use your skills to help extend care to all of our communities. Summary Works collaboratively with the Compliance Manager on creating auditing protocols which align with Bon Secours Mercy Health’s overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed for Bon Secours Mercy Health. • Please note this role is remote, but requires living in the continental US and working hours in alignment with Eastern Time.* Essential Job Functions • Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and abuse. • Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and/or other enforcement agencies on behalf of Bon Secours Mercy Health. • Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues. • Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas • Assists in auditing and investigations requested by the System Director, Compliance. • Assists in the development of compliance corrective action plans (CAP), oversight tools and technical edit enhancements to support revenue cycle services compliance and privacy efforts. • Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. • Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking. • Ensures that the System Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status. • Develops educational content on documentation, coding, and trending of non-compliant activities to enhance compliance proficiency and competency, understanding of standards and the consequences of non-compliance. • Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities. Qualifications • CCS, CPC, RHIT, or RHIA required. • Auditing Experience, Experience with EPIC Electronic Medical Records System preferred. • Two to four years of in-depth experience within healthcare operations, healthcare auditing, or coding/billing either from a consulting perspective or as an employee/manager required. • Demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies, as well as extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations and compliance guidance required. • Excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations preferred. Many of our opportunities reward* your hard work with: Comprehensive, affordable medical, dental and vision plans Prescription drug coverage Flexible spending accounts Life insurance w/AD&D Employer contributions to retirement savings plan when eligible Paid time off Educational Assistance And much more • Benefits offerings vary according to employment status All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com