Value Based Clinical Data Specialist
The Value Based Clinical Data Specialist will serve as a key support between Adelante Healthcare and the patient population as attributed through Value Based Contracts with all lines of Business under the Value Based leadership. The person in the position will develop and maintain strong relationships with our patients and help schedule patients for care and be responsible for achieving the team based and individual goals as outlined for the Value Based Care team. The Value Based Program Clinical Specialist will help support patients and increase engagement, overcome barriers and act as additional support to our provider teams and work to achieve the Value Based incentives as outlined in Adelante’s contracts. In addition, this position also helps address and close gaps in care and other care coordination efforts for a patient centric experience.
Every Adelante Healthcare employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected to work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism, and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE:
Two (2) or more years’ experience in a clinical setting
High school diploma or GED from an accredited institution
Graduation from an accredited medical assistant program
Certification to perform cardiopulmonary Resuscitation for the Health Care Professional (CPR) and AED through courses that follow the guidelines from the American Heart Association and Red Cross (cognitive and skills evaluations)
Demonstrated understanding of clinical methods and techniques used in record keeping systems
Demonstrates continuous attention to detail
Effective communication demonstrated by ability to read, interpret, comprehend and comply with written and verbal communication
Ability to communicate effectively with patients, co-workers, and our communities both in person and over the phone
Ability to multi-task and work effectively in a high-stress and fast-moving environment
Exceptional customer service, communication skills, problem solving and organizational skills
Previous call center experience strongly preferred
Strong computer efficiency in Microsoft Office suite (Word, Excel, PowerPoint, Outlook) and experience in Electronic Healthcare Records (EMR)
Works independently to meet deliverables and performs a variety of assignments requiring independent judgment.
Provides and accepts support in a collaborative manner
Able to meet the organization’s immunization requirements
Participate in Value Based Care team meetings and improvement initiatives, staff meetings, in-service meetings, or other required meetings
Engage patients and promotes health care gaps compliance through health and disease patient education
Extensive outreach efforts for well visits, high-risk patients, preventative screenings, and/or other populations as needed.
Obtain patient records through various sources such as external portals or using our internal medical record request process.
Reconcile medical records to and from the Electronic Health Record to ensure patient data is up to date within our EHR and the insurance provider.
Ensure that patient documentation is available for uploads to reflect accuracy.
Promote clear communication and ensures patient needs and requests are handled efficiently by communicating to the patients care team through our EHR and scheduling of patient initial and follow up appointments as needed
Perform administrative tasks like (but not limited to) Portal Uploads, Release of records, Referral Notes for any open active orders (3-6months), confirming appointments, etc.
Help manage high-risk patient care, including management of patients with multiple co-morbidities and/or high risk for readmission to a hospital setting, including data entry/management, outreach attempts, and scheduling to improve patient outcomes.
Work collaboratively with Value Based Care team for data collection, reporting, clinical audits and programmatic evaluation.
Will perform high volume of daily patient outreach calls while still attending to incoming calls.
Perform patient pre-registration including accessing and updating patient information as indicated
Perform data entry
Maintain schedule accuracy for maximum patient flow
Follow established procedures for answering and screening incoming appointment-related telephone calls, scheduling interpreters, and directing calls to appropriate staff
Constantly sustains and improves present expectations of internal and external patient clinical goals.
Maintain good attendance, is punctual and works full scheduled shift
Coordinates continuity of patient care with external healthcare organizations and facilities such as referrals to outside specialties; ongoing two-way communication between providers.
Maintain effective communication with team, office staff and providers across all health centers as needed
Facilitate patient care based upon standing orders and protocols.
Ensure patient needs and requests are handled efficiently by performing telephonic patient scheduling of patient initial and follow up appointments.
Identify preventable exams, gaps in care, and suspect conditions closure opportunities for payors and strategize submission in a timely manner.
Consolidate submission outcomes in a clear and concise manner.
Ensure all data is always ready and available as needed for further evaluation.
Ensure payor audit needs and request are handled in an efficient and timely manner.
Facilitate payor audit visit for in house medical record extraction and ensure compliance of visitors
NONESSENTIAL SKILLS AND EXPERIENCE:
Bilingual (Spanish/English preferred)
Additional Duties and Responsibilities
Other duties as requested or assigned
Patience-Centered Medical Home (PCMH)
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team-based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.