Director – Provider Education & Risk Adjustment

Overview

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The Physician Educator serves as a liaison between the Health Plan and the participating providers. They are the primary resource for participating providers to address issues, questions and learning needs related to coding and documentation in the medical record and the various risk adjustment models of payment. The Physician Educator is responsible for education of the participating providers and their staff. This includes assessment of learning needs, assessment of workflow processes and identification of barriers that impact correct coding documentation. They are responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. The Physician Educator distributes provider reports to physicians and practice management staff to assist them in improving their outcomes related to risk adjustment. In addition, they are responsible for evaluating medical record documentation through the medical record review process and providing feedback and recommendations for improvement. They will provide feedback to Operations-Risk Adjustment management and work collaboratively and cooperatively with Network Management, Reimbursement and other Health Plan department as required. The Physician Educator maintains a positive and helpful attitude as a liaison to the participating providers of Elderplan.

This is a full-time position working Monday through Friday at variable daytime hours.  This will be a position based in NY requiring 50-75% travel primarily in the 5 boroughs, and surrounding areas as needed. 

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

•    Develop and maintain collaborative relationships with assigned providers/practices within Elderplan Network.
•    Coordinate and present education of providers/practices related to risk adjustment, coding, and clinical documentation improvement.
•    Assess workflow processes in physician practices that impact the ability to maximize Health Plan revenue achieved through the various risk adjustment payment models.
•    Identify trends and barriers that interfere with correct coding and documentation practices in the physician practice sites, including but not limited to workflow, electronic health records, and clearinghouses.
•    Adhere to CMS coding and documentation guidelines.
•    Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
•    Analyze and distribute reports to providers that summarize their performance related to coding and documentation and risk adjustment.
•    Develop and implement strategic action plans based on findings of assessment of physician practice workflows and medical record documentation reviews.
•    Maintain confidentiality of chart review results and member information.
•    Maintain a current and in-depth knowledge of CMS guidelines related to risk adjustment, coding, documentation, as well as knowledge of new models of risk adjustment that impact Health Plan revenue.
•    Track all educational activities and trends and patterns of providers/practices.
•    Assist practice with integration of correct coding and documentation standards into workflow.
•    Troubleshoot issues that impact the integration of correct coding and documentation and maximization of Health Plan revenue.
•    Monitor on-going performance of physicians and practices and report findings to the providers, practice administrators, and Risk Adjustment management. Identify sites within the network to offer public education on coding and documentation and provide classes on a regular basis.
•    Identify and document best practices related to coding, documentation, and workflow and share with practice administrators and risk adjustment physician educator staff.
•    Collaborate with practices that have entered into shared savings arrangements with Elderplan and assist them with identifying strategies that will improve their quality of patient care and maximize risk adjustment revenue.
•    Assist Vice President in development of education objectives and programs.
•    Collaborate with Risk Adjustment management staff in the development and implementation of the annual Risk Adjustment prospective campaigns.
•    Collaborates with Network Management, Reimbursement, Claims, and other Health Plan departments as required.
•    Ensures appropriate staffing and resources to support department/agency services. Monitors productivity throughout the year and participates in annual budget preparation.
•    Interviews and participate in the selection process for qualified staff in collaboration with Human Resources and Senior Leadership.

Qualifications

•    Bachelor's Degree required or comparable work experience will be considered.
•    Minimum 5 years of experience in professional services, including practice management, nursing, clinical documentation improvement or quality audit.
•    2-3 years of teaching experience in a clinical setting preferred.
•    2-3 years of progressive leadership experience preferred.
•    Extensive knowledge of coding and documentation requirements including ICD-10-CM, CPT-4, and HCPCS. In-depth knowledge of medical terminology, anatomy and physiology, pharmacology, and pathology required.
•    A general understanding of Health care insurance and Medicare managed care is highly preferred for this position.
•    Excellent verbal and written communication skills, analytical skills, and organization skills required.
•    Extensive problem-solving experience is required.
•    Experience working with physicians and physician practices. Goal-oriented and experience with development and implementation of action plans.
•    Excellent customer service required.
•    Ability to interact with public in a diplomatic and tactful manner and represent the Health Plan effectively.
•    Ability to manage relationships with assigned practices and maintain records of all activities.
•    Ability to develop action plans as required.
•    Proficient computer skills.
•    Self-motivated with the ability to work with minimal supervision.

Min

USD $175,000.00/Yr.
Max

USD $200,000.00/Yr.