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Gonzaba Medical Group · 1 month ago

Risk Adjustment Data Entry (On-Site)

San Antonio, TX

Full-time

Onsite

New Grad, Entry Level

Gonzaba Medical Group is seeking a Risk Adjustment Data Entry specialist to improve the documentation of acuity for their patient population. The role involves maintaining accurate patient databases, supporting managed care projects, and ensuring compliance with confidentiality and HIPAA requirements.

Health CareMedical

Responsibilities

Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy

Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers

Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication

Participates in other Managed care projects to include but not limited to marketing events, and Medicare Open enrollment period

Reviews reports to identify areas for improvement or needed action to meet departmental goals

Supports team members in all aspects of the Risk Adjustment process to ensure that defined timelines and departmental goals are met

Adhere to all confidentiality and HIPAA requirements as always outlined within Gonzaba Medical Group Operating Policies and Procedures in all ways and with respect to any aspect of the data handled or services rendered

Other duties as assigned

Maintain accurate database of GMG capitated patients, update database monthly from enrollment and disenrollment reports

Accurately update the database to track each stage of the RMH process. This is vital to an effective process and accurate reports

Prepare audit documents as defined; create logical batches for reviewers

Process completed audits for timely data entry into EMR

Assist with teaching clinical staff how to identify patients needing RMH review, preparing RMH notes for the provider, and processing RMH encounter notes; also teach how and when to schedule future RMH appointments

Keep PCP, clinical staff and Managed Care team members informed of pertinent findings/issues uncovered

Track & report completed RMH DOS for CMS submission

Qualification

Database managementEMR data entryClinical competenciesHIPAA complianceCustomer service

Required

All duties performed will be done accurately and in a timely manner

Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy

Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers

Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication

Participates in other Managed care projects to include but not limited to marketing events, and Medicare Open enrollment period

Reviews reports to identify areas for improvement or needed action to meet departmental goals

Supports team members in all aspects of the Risk Adjustment process to ensure that defined timelines and departmental goals are met

Maintain accurate database of GMG capitated patients, update database monthly from enrollment and disenrollment reports

Accurately update the database to track each stage of the RMH process

Prepare audit documents as defined; create logical batches for reviewers

Process completed audits for timely data entry into EMR

Assist with teaching clinical staff how to identify patients needing RMH review, preparing RMH notes for the provider, and processing RMH encounter notes

Keep PCP, clinical staff and Managed Care team members informed of pertinent findings/issues uncovered

Track & report completed RMH DOS for CMS submission

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 15 lbs

Close vision and ability to adjust focus

Must be able to work efficiently under pressure