The Polyclinic

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Regional Medical Director, Risk Adjustment

at The Polyclinic

Posted: 11/16/2019
Job Reference #: *1127AF2D37DC378B
Keywords: operations

Job Description

Requisition Number
19-0844

Post Date
11/26/2019

Title
Regional Medical Director, Risk Adjustment

City
Seattle

State
WA

Description

Hours: Full Time; Monday - Friday; 8:30 - 5:00
Location: The Polyclinic 1145 Broadway

JOB SUMMARY:

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 OptumCare’s 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 OptumCare’s 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.


Requirements

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.