Description
PURPOSE OF THIS POSITION
The purpose of the Director of Value-Based Care & ACO is to advance the organization's value‑based care performance by providing strategic and operational leadership for the Clinically Integrated Network and Accountable Care Organization programs; ensuring high‑quality clinical documentation and coding; equipping clinicians and staff with the education needed to meet regulatory and contractual requirements; and guiding data‑driven performance improvement efforts that strengthen financial, clinical, and operational outcomes.
JOB DUTIES/RESPONSIBILITIES
Duty 1: Oversees the Clinically Integrated Network program administration and Accountable Care Organization program administration.
Duty 2: Work collaboratively with the Director of Corporate Quality & Value Based Care and closely with the Value-Based Care team to support strategic, operational, and performance initiatives that drive success across value-based care contracts.
Duty 3: Health Information Services (HIS) team to enhance coding capture, improve documentation quality, and maintain compliance with applicable guidelines and regulations.
Duty 4: Participation in initiating, planning and leading multidisciplinary teams to describe and improve value-based contract / program performance.
Duty 5: Develops educational materials and provides in-service training to physicians and office staff in the areas of related to Value Based Care and the Clinically Integrated Network requirements. This would include but not limited to annual wellness visits, transitional care management visits, medical decision-making documentation for other evaluation/management visits.
Duty 6: HCC Coding: Design, implement, and oversee the Hierarchical Condition Category coding program for BVHS, encompassing Primary Care and Specialty services; provide education and guidance to providers, ensure accurate and compliant documentation, monitor performance metrics, and support organizational risk adjustment initiatives.
Duty 7: Act as the primary lead with our Accountable Care Organizations on coding, Hierarchical Condition Category, and Risk adjustment Factor-related initiatives; develop, implement, and monitor a collaborative program to support accurate risk adjustment, compliance, and performance goals.
Duty 8: Lead and perform coding audits across services to ensure accurate, compliant documentation and coding; develop, implement, and monitor corrective action plans based on audit results.
Duty 9: Maintain current knowledge of coding trends, regulatory requirements, and industry best practices; design, develop, and implement educational initiatives to ensure consistent, accurate, and compliant coding across the organization.
- Duty 10: Oversee the ambulatory data analytic personnel to monitor VBC performance.
REQUIRED QUALIFICATIONS
Degree in Health Information Management, Nursing, Healthcare Administration, Health Informatics or other related field or equivalent work experience.
Three years' experience in HCC/risk adjustment related coding, clinical documentation improvement, provider and/or value-based care.
Required credentials include Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certification in Outpatient Clinical Documentation Integrity (CDEO or CCDS-O), or equivalent credentials or obtained within 12 months of starting position.
Hybrid work position with travel required between medical practices in the BVHS service area.
A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within 30 days of your residency in the state). You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle.
Possess advanced understanding of coding classification systems (ICD-10-CM, CPT, HCC, etc.), thorough knowledge of revenue cycle and reimbursement processes, including risk adjustment methodologies.
Understand audit standards and process, ability to perform trend analysis to identify opportunities and create actionable items to demonstrate improvement.
Strong knowledge of regulatory and compliance requirements; ability to seek out and research coding related topics through resources such as Coding Clinic, CPT Assistant, CMS websites, CIN/ACO resources, etc.
Ability to work independently and meet deadlines.
Ability to provide clear, concise, and effective education to individuals or groups. Skill in analyzing and effectively presenting data and complex information to various audiences, including leadership. Ability to build trust and credibility.
Capable of managing multiple tasks/projects with excellent organizational, time management, and prioritization skills. Self-motivated.
Proven proficiency with computer applications, including Microsoft Office (Excel, Word, PowerPoint), and healthcare-specific tools like Encoder.
Thrives in a fast-paced, creative environment, moving independently between tasks.
Makes sound decisions quickly, maintains professional conduct, and works well with others on both individual and team levels.
Positive service-oriented interpersonal and communication skills required.
PREFERRED QUALIFICATIONS:
Experience with integrated health systems, ACOs, or Medicare Advantage plans, HHS ACS risk adjustment programs.
Familiarity with EHR workflows (e.g., Epic, Cerner) and clinical analytics tools (e.g., payer RAF portals, STARS dashboards)
Experience with Oracle (Cerner) and 3M 360E CAC program
PHYSICAL DEMANDS
This position requires a full range of body motion with intermittent walking, lifting, bending, squatting, kneeling, twisting and standing. The associate will be required to walk for up to one hour a day, sit continuously for six hours a day and stand for one hour a day. The individual must be able to lift twenty to fifty pounds and reach work above the shoulders. The individual must have good eye-hand coordination and fine finger dexterity for simple grasping tasks. The individual must have excellent verbal communication skills to perform daily tasks. The associate must have corrected vision and hearing in the normal range. The individual must be able to operate a motor vehicle for business travel and community involvement.
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