Administrative -

Primary Responsibilities:

Clinical risk adjustment and documentation education
o Provides ongoing targeted mentoring and education to physicians and APCs on appropriate diagnosis coding and supporting documentation including
Risk education sessions and materials for clinicians in both primary care and specialties
Organization-wide training on changes or updates to risk adjustment models
Programs designed to ensure all diagnosed conditions and appropriate codes are supported by documentation in the patient chart
o Educates physicians and APCs to ensure appropriate practices related to risk adjustment activities HEDIS measures and gaps in care throughout the market.
o Works with the Medical Director Risk Adjustment to establish a competency baseline for provider performance. Monitor the progress of providers receiving mentoring and develop tailored strategies to improve performance.
o Informs physicians and APCs around year-over-year changes to the Medicare risk adjustment to provide thought leadership and assists in carrying out recommended actions.
o Provides clinical support for embedded nurse practitioner programs.
o Supports clinical documentation education program alignment and prioritization across the region.
Partnership with operational leaders:
o Builds/maintains/manages market stakeholder relationships across multiple layers and functions.
o Monitor wrap around programs for effectiveness and assist in coordination adoption and resolving barriers as needed to achieve outcomes.
o Participates in regulatory and accreditation activities as applicable
Emotional maturity for effective change management
o Establish solid and lasting trust-based relationships within team and external partners
o Foster exemplary teamwork and strengthen a culture of continuous improvement and accountability
o Take initiative and self-start attitude to approach problems with energy and passion
o Demonstrate preference for working in a tight-knit team environment with diverse professional groups
o Utilize a solid fact base to influence and lead physicians and support staff to implement change programs
Ensures overall program success
o Reducing barriers for program implementation teams including anticipating and responding to potential roadblocks
o Active problem solving to meet evolving challenges in a highly dynamic environment
o Distributing performance management reporting to market leaders and synthesizing information for adjustment and optimization
o Conducts deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
o Works collaboratively to inform new innovative or complimentary program ideas at scale
o Collaborates with other team members to align on meeting expectations and material preparation
o Interacts with senior management by providing thoughtful analysis on key decision points to drive initiatives forward


Required Qualifications:

M.D. or D.O. degree
Current unrestricted license to practice medicine
Board certified in Family Medicine or Internal Medicine
5 years of clinical experience
Direct experience with Risk Adjustment diagnosis coding as a provider
Solid knowledge of electronic health records including experience in chart review
Demonstrated ability to influence without authority
Demonstrated ability to successfully operate in a dynamic and changing environment
Demonstrated ability to implement complex programs and monitor implementation and necessary modifications
Demonstrated ability to manage multiple priorities and deadlines in an expedient and decisive manner
Proven innovative thought process and problem-solving skills
Demonstrated solid presentation skills; ability to achieve change management in a matrixed environment; ability to speak clearly and lead discussions with senior executives and large groups
Demonstrated solid verbal and written communication skills
Willing or ability to continue to see primary care patients



Preferred Qualifications:

Proven solid baseline knowledge of Risk Adjustment and other Pay for Performance Programs
Demonstrated ability to understand and navigate the organizations culture; able to think both strategically and tactically; respected by peers; maintains competency and enhances professional growth and development through continuing education; general understanding of disparate systems and integration/information flow
Demonstrated ability to form solid relationships with peers in practice and leadership
Proven credibility among the medical staff as a provider
Proven belief in and enthusiasm for the role of Pay for Value to improve the delivery of care
Proven effective listening and negotiating skills and patience