HCC Physician Educator (Non-Licensed MD)

HCC Physician Educator (Non-Licensed MD)
Simi Valley, CA
$90,000 - $100,000 / Year is the amount that CareNational reasonably expects to pay someone for this position.
 
Job Summary: 

The HCC Physician Educator is responsible for auditing, scoring, and maintaining medical records, charts, and files for the purpose of ensuring accurate coding and reimbursement. They will report directly to the CFO. The ideal candidate will have a strong understanding of HCC codes and the risk adjustment process, as well as experience in medical coding and auditing. They will also be able to effectively communicate with providers and staff to educate them on HCC compliance requirements. Driving will be required as needed for off-site meetings. 

Responsibilities:

1. Audit provider patient charts and analyze for proper documentation. This includes reviewing the subjective, objective, assessment, and plan sections of the chart to ensure that all required information is present and accurate. The auditor should also review other chart documents, such as clinical lab results and pharmacy interactions, to identify potential conditions that the provider may not have listed.
2. Review audit findings with the provider and provide any substantiating medical background to the findings. This includes explaining the findings to the provider and providing any supporting medical information that may be helpful. The auditor should also work with the provider to develop a plan to address any deficiencies in the documentation.
3. Ensure that the provider performs proper follow-up to provide care for the patient as indicated in the audit findings. This includes tracking the provider's progress in addressing the deficiencies and providing additional support as needed.
4. Train and mentor Risk Adjustment staff. This includes providing training on HCC risk adjustment, coding, and documentation requirements. The auditor should also mentor staff on how to conduct audits and identify potential problems.
5. Be accountable for increasing the company's RAF score in order to place the company within the upper quartile of the industry. This includes working with providers to improve their documentation and ensuring that all required information is present. 
6. Serve as the HCC physician champion in interfacing with all levels of management. This includes representing the interests of the HCC program to management and providing updates on the program's progress. The auditor should also work with management to develop and implement strategies to improve the program.
7. Aid in the design and implementation of HCC incentive programs. This includes working with management to develop programs that will motivate providers to improve their documentation. The auditor should also track the effectiveness of these programs and make recommendations for improvement.
8. Establish provider relationships and ensure problem resolution. This includes building rapport with providers and working with them to resolve any problems that may arise. The auditor should also be proactive in identifying potential problems and working with providers to prevent them from happening.

Qualifications: 

• Must have a bachelor's degree in a healthcare-related field, such as nursing, medicine, or health administration. A masters degree is preferred. 
• 5+ years of experience in medical coding, documentation, and auditing.
• 5+ years of experience teaching, training, educating, and/or coaching physicians to improve documentation. 
• 1+ year of Managed Care experience preferred (i.e., Health Plan, TPA, HMO, etc.). 
• Strong knowledge of HCC risk adjustment, coding, and documentation requirements.
• Strong communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Excellent organizational and time management skills.
• Proficiency in Microsoft Office Suite. 
• Must be able to travel in the area and have a valid drivers license and insurance.