Value-Based Care Quality & Coding Nurse

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MedCap Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

MedCap Health is a physician-led, multi-specialty organization that provides clinical support and subspecialty services to post-acute care settings including skilled nursing facilities (SNFs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), assisted living facilities (ALFs), and independent living facilities across 15+ states. Their model emphasizes daily on-site physician rounding, collaboration with nurse practitioners and physician assistants, embedded subspecialty integration, medical director leadership, telemedicine roles, and value-based frameworks. They offer services for high-acuity post-ICU programs, ventilator and trach units, transitional care, and chronic disease management with outcomes including reductions in hospital readmissions and falls.

📋 Description

• Identify open quality gaps (e.g., HEDIS-aligned ACO quality measures, MIPS measures, Annual Wellness Visit completion, screening and preventive care measures) across beneficiaries using ACO/EHR/claims data. • Prioritize outreach based on gap type, time remaining in the performance year, and impact on overall quality score. • Direct and coordinate with providers and care teams to close gaps - scheduling outreach, flagging patients due for services, and following up until gaps are documented as closed. • Track gap closure progress against internal targets and CMS reporting deadlines; escalate stalled cases to practice leadership. • Serve as the point of contact between the ACO/VBC program and participating providers/practices on quality performance. • Provide point-of-care coaching on documentation requirements needed to satisfy quality measure specifications. • Support providers in building repeatable workflows (pre-visit planning, standing orders, registries) so gap closure becomes part of routine care rather than one-off outreach. • Manage and interpret large datasets from CCLF/claims feeds, EHR extracts, and quality reporting platforms to identify trends, outliers, and at-risk populations. • Maintain gap lists, dashboards, and tracking tools; validate data accuracy against source systems. • Partner with analytics/IT to troubleshoot data discrepancies (e.g., attribution mismatches, missing encounters, lag in claims). • Review clinical documentation and claims history to identify suspected but unreported HCC/risk-adjustment coding opportunities and recapture needs. • Flag chronic conditions requiring annual recapture and communicate findings to providers ahead of or during visits. • Support coding accuracy education for providers (specificity, documentation linkage, recapture cadence) in partnership with coding/compliance staff. • Monitor RAF trends and coding capture rates at the practice and provider level. • Ensure all outreach and documentation activities comply with CMS MSSP/ACO REACH/LEAD program requirements and applicable privacy regulations (HIPAA). • Support preparation of quality data for CMS submission windows and internal audit readiness. • Maintain accurate records of all gap-closure and coding-opportunity activity for audit and performance reporting purposes.

🎯 Requirements

• Active nursing license. • 2+ years of experience in long term care, value-based care, quality improvement, or care management. • Demonstrated ability to work with large datasets (claims, EHR extracts, registries) in Excel or reporting/BI tools. • Strong provider-facing communication skills; comfortable directing and holding providers accountable to timelines. • Excellent organizational skills and ability to manage multiple concurrent gap-closure workstreams. • Experience with CCLF data, ACO quality reporting tools, or risk-adjustment/coding software. • Certified Risk Adjustment Coder (CRC) or similar coding credential. • Familiarity with EHR systems commonly used across a multi-practice network. • Prior experience in an ACO, health system population health department, or MSO.