ACO Quality Nurse (San Antonio, TX)

The ACO Quality Nurse will be responsible for engaging directly with ACO and CIN primary care practices to provide education, reports and tools that support improved coding documentation, patient engagement and key quality performance indicators. Growth for our networks will increasingly be driven by Medicare Advantage, Medicare ACO and Exchange programs that require providers to execute on initiatives that support the correct risk of an aligned patient population. As such, Tenet�s ACO/CIN success will be dependent on improving these quality functions and directly supporting the related educational needs for our network practices. The position will more specifically be responsible for the following:

• Functioning independently, travel within the market to meet with assigned providers to discuss Tenet ACO tools and programs focused on improving the quality of care for Medicare and Exchange members
• Improve practice accountability for meeting network quality metrics by being present in the practices 70-80% of time with rare occasion of overnight travel
• Utilizing Tenet and Conifer tools, identify and prioritize providers who would benefit from coding, documentation and quality training and resources
• Establish positive, long-term, relationships with physicians, practice managers and practice clinical teams
• Develop comprehensive, provider-specific targets for improving coding accuracy and related RAF performance
• Develop a standard Health Risk Assessment Form that will ensure correct documentation is assessed for network patients that results in more accurate provider payments and more accurate data to contracted payers
• Educate practice on gaps in care needs and related portal reporting
• Assess EMR/EHR barriers where it is causing issues in meeting CMS standards of documentation and coding
• Partner with other ACO department leaders to develop and implement ongoing tools and materials that support quality improvement and the importance of proper chart documentation of procedures and diagnosis coding
• Assist practices in understanding network quality metrics and ongoing practice performance
• Educate practice teams by auditing documentation to ensure it supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
• Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
• Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
• Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
• Provides actionable solutions to providers, including practice workflow suggestions, that will result in improved accuracy for documentation and coding practices
• Collaborates with Tenet case management and applicable facility staff on risk adjustment and quality education efforts
• Direct patient outreach for chronic patients where required by contract and coordination with payer case management programs

This position will work closely with the Regional Director of Network Operations to coordinate seamless communication and education for ACO and CIN practice needs.

The individual in this role will collaborate with other department leaders to drive initiatives that improve the ACO and CIN strategy.

• Nursing background (i.e., LPN, RN, NP, CMA)

• Bachelor�s degree in Health Care or related field, or the equivalent combination of education and/or experience.

• 4+ years of provider, health plan or hospital experience

• Certified Professional Coder / CPC-A; CRC certification; CCS, RHIA, or willing to obtain CPC within 6 months

• Knowledge of ICD-10

• Excellent analytical abilities - proficiency in MS Office and Excel

• Must be able to work effectively with common office software, coding software and EMR systems
  

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.