Risk Adjustment Professional

Activity description 

These materials are only intended for those that participated in the Risk Adjustment Professional on-demand education.

The Risk Adjustment Professional course is a comprehensive program designed to equip non-clinical team members with the knowledge and skills needed to excel in the field of risk adjustment, specifically within the context of Medicare Advantage (MA) programs. The course covers a broad range of topics, including:

  • Foundational knowledge: The history and principles of managed care and risk adjustment, along with the roles of payers and clinicians.
  • Core risk and coding principles: The importance of accurate documentation and the process of chart review.
  • Technology and tools: The various tools and platforms used for suspect generation, coding and data submission.
  • Department structure: The different teams within the Risk Adjustment Department and their respective functions.

Overall, the program emphasizes compliance, accuracy and collaboration as key elements in achieving successful risk adjustment outcomes and improving the health of members.

Provided by
This activity is jointly provided by Optum Health Education and WellMed.

Commercial support
There was no commercial support received for this activity.

Required hardware/software
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Target Audience

This activity is designed to meet the educational needs of coders, nurses, nurse practitioners, PAs and physicians who have an interest in obtaining knowledge and skills needed to excel in the field of risk adjustment, specifically within the context of Medicare Advantage (MA) programs.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Explain the key features and history of Medicare Advantage and its relationship to risk adjustment practices. 
  • Identify and describe the core principles of managed care and how risk adjustment interacts with other aspects within a managed care organization. 
  • Analyze the role of payers in the risk adjustment ecosystem and explain how effective relationships with payers contribute to successful outcomes. 
  • Develop strategies to increase clinician engagement, including identifying different types of clinicians and methods for education and collaboration. 
  • Apply accurate coding practices to risk adjustment data, including understanding components, attestations and chart review processes. 
  • Utilize technology tools such as Atlas and Aries to identify potential undiagnosed chronic conditions in patients. 
  • Navigate and utilize the DataRAP® medical coding application and other relevant software programs such as Zephyr and ePRG to manage risk adjustment data effectively. 
  • Describe the data submission process for risk adjustment, including data flow, workflow, reconciliation and deletion procedures. 
  • Explain the role of the WellMed risk adjustment platform and how it supports other care delivery organizations. 
  • Identify the various teams within a Risk Adjustment Department and their respective contributions to optimizing member/provider connections, ensuring accurate coding and ultimately improving patient health. 
Activity summary
Available credit: 
  • 12.00 AAPC - Coders
  • 12.00 AMA - Physicians
  • 12.00 ANCC - Nurses
  • 12.00 Attendance - General Attendance
Activity opens: 
Activity expires: 

Kimberly Albrightson, LVN, BSHA, MAOM
Director, Clinical Analytics

Daniel Coffey, MBA
Manager, Risk Adjustment Submissions

Kimberly Davis, DNP, RN, ACNS-BC, CPC-A,
Vice President, Risk Adjustment

Mark Faulkner. PA-C
Clinical Director of Provider Education

Lois Gordon
Senior Director, Portal Solutions

Sheri Howell, BSN, RN, MSN/MBA
Senior Vice President, Risk Adjustment

Vadym Sholomytskyy
Risk Adjustment Submissions Manager, DataRAP Operations

Mary Wilson, CPC, CRC
Senior DataRAP Trainer

Gaye Lynn Werner, RN, BSN, CPC, CRC
Vice President, DataRAP Operations

Activity planner
Rebecca Gleason, RN
Clinical Activity Manager
Optum Health Education

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, Optum Health Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty or planners have no financial relationships to disclose.

Accreditation statement
Joint Accreditation LogoIn support of improving patient care, this activity has been planned and implemented by Optum Health Education and WellMed. Optum Health Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit designation statements

Optum Health Education designates this live activity for a maximum of 12.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

The participant will be awarded up to 12.0 contact hour(s) of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

AAPC-certified coders
This program meets AAPC guidelines for 12 CEUs. Can be used for Core A, CDEO, CIC, CRC, CPMA and CPCO with successful completion of post-test for continuing education units. Index #OPTM0318241114A

A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.

Available Credit

  • 12.00 AAPC - Coders
  • 12.00 AMA - Physicians
  • 12.00 ANCC - Nurses
  • 12.00 Attendance - General Attendance
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