Risk Adjustment Medical Director (Hingham)

DaVita in Hingham, MA

  • Industry: Executive Management - Administrative/Operational Support
  • Type: Full Time
  • $166,545.00 - 167,060.00
position filled

Responsible for administration and oversight of the medical and clinical activities of employed and contracted providers as well as various operations within their region designed to ensure appropriate practices related to risk adjustment activities, HEDIS measures, and any appropriate gaps in care. The Medical Director works collaboratively with Risk Adjustment Program Director, NP Clinical Educator team, other Regional Medical Directors, coding department, lead physicians, site administrators, and primary care physicians to educate and improve accurate coding and documentation skills, leading to a more complete patient record.

The Risk Adjustment Medical Director is responsible to lead efforts to improve risk adjustment programs including accurate documentation and coding within their region, and be accountable for those improvements and outcomes. The Director acts as a resource for national and network leadership as well as lead physicians, primary care physicians, specialists, and hospitalists.

The Risk Adjustment Medical Director is further responsible for keeping up to date on changes in the Medicare risk adjustment model or other documentation requirements.

ESSENTIAL FUNCTIONS:

  • Serve as a resource for the region, network, and national operations on proper coding and documentation.
  • Attend and participate as requested in regional and national meetings that pertain to coding and documentation.
  • Educate and mentor NP educator team, employed and contracted PCPs, hospitalists and specialists on risk adjustment and documentation requirements.
  • Responsible for onboarding, ongoing, and targeted education of all physicians on coding and documentation for Medicare risk adjustment.
  • Be accountable for the overall improvement and performance in risk adjustment metrics.
  • Attend network and clinic site meetings as appropriate to present material on coding & documentation.
  • Review charts to aid in the education process, and discover opportunities to improve accurate coding and documentation.
  • Develop ongoing chart review process to ensure continued high standards in documentation and coding, as well as aid in developing and monitoring inter-reviewer reliability testing.
  • Attend courses as needed to improve knowledge of coding and documentation.
  • Meet monthly with Network Risk Adjustment Medical Director and Risk Adjustment Senior Director; send updates on activities weekly to network risk adjustment leadership and clinical operations teams.
  • Consistently exhibits behavior and communication skills that demonstrate OptumCares commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Coordinates implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart. Programs include, but are not limited to, training and educational activities and coordination of random targeted documentation audits and concurrent follow up feedback.
  • Coordinates with clinician leadership to ensure the clinical aspects of risk adjustment programs and best practices are communicated to group and IPA providers.
  • Oversees preparation and implementation of clinical correlation studies.
  • Interfaces with operational leadership to assist in identification of operational and clinical best practices in maximizing patient visits, re-evaluation rates and accurate and proper coding; coordinates the dissemination of best practices to sites, clinicians and IPAs providers / support staff.
  • Coordinates sharing of best practices related to risk adjustment activities with other regions within the network.
  • Uses, protects, and discloses OptumCares patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Assist Risk Adjustment Senior Director in meeting compliance and regulatory standards
  • Performs additional duties as assigned.

____________________________________________________________________________________________________

JOB SPECIFICATIONS:

EDUCATION: MD or DO.

LICENSURE:

  • Current and Unrestricted license to practice medicine in the State of Washington.
  • Current and Unrestricted DEA certificate

EXPERIENCE:

  • Minimum 3 years of practicing medicine
  • Over 2 years of CMS-HCC operations experience
  • Over 3 years of supervisory experience.
  • Licensed physician in the state of Washington, with knowledge of the coding/billing/documentation
  • Ability to engage contracted providers through indirect influence

ESSENTIAL TECHNICAL/MOTOR SKILLS:

  • Excellent range of knowledge with respect to the practice of medicine. Ability to speak clearly and communicate with patients, families, agencies, other physicians and staff regarding patient care.

INTERPERSONAL SKILLS

  • Ability to develop positive interaction with patients, families, physicians, administrators and co-workers in order to effectively care for the patient.

PHYSICAL REQUIREMENTS IN ACCORDANCE WITH ADA:

  • Carrying/Lifting: Occasional / 0-10 lbs
  • Standing: Constant / Up to 10 hours per day
  • Sitting: Constant / Up to 10 hours per day
  • Walking: Constant / Up to 10 hours per day
  • Repetitive Motion: Keyboard activity, telephone use, writing
  • Visual Acuity: Ability to view computer monitor and read newsprint with or without corrective lenses
Posted 30+ Days Ago

Full time

R0068861

About Us

DaVita Medical Group is a division of DaVita Inc., a Fortune 500 company, that operates and manages medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading independent medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. DaVita Medical Groups teammates, employed clinicians and affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Groups leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu. For more information, please visit? DaVitaMedicalGroup.com .

We offer a competitive wage and a comprehensive benefits package which includes insurance programs covering medical, dental, vision, life, long-term disability, paid time off, education reimbursement, and a 401(k) plan.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.


Associated topics: care, clinic, family medicine, family practice, family practice physician, general practice, nocturnist, physician, primary care, urgent care

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