|Skills:||CPC,CRC,Coder,Coding Trainer,Healthcare,Managed Care,Medicare,Risk Adjustment
|Specialties:||Risk Adjustment consultation
|Required Certifications:||CPC or CRC
|Preferred Certifications:||CPC or CRC
|Required Experience:||5 to 7 years
|Preferred Experience:||8 to 10 years
|Location:|| Boston 02110, MA, US
Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
The Practice Consultant is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy. The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will review charts (paper and electronic - EMR), identify gaps in care, and educate providers and offices to ensure they are coding to the highest specificity. Work is primarily performed at physician practices on a daily basis.
If you are located in the Boston, MA, area you will have the flexibility to telecommute* as you take on some tough challenges in this largely field-based role.
Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and incentive programs focused on improving the quality of care for Medicare Advantage Members
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes
Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Provider Scorecard) to analyze data and prioritize gap closure, identify trends and drive educational opportunities
Conduct chart review quarterly and provide timely feedback to provider to implement change on a go forward basis.
Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution.
Training will include Stars measures (HEDIS/CAHPS/HOS/medication adherence), risk adjustment coding practices, and Optum program administration, use of plan tools, reports and systems
Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
Facilitate/lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
Partner with providers to engage in UnitedHealthcare member programs such as HouseCalls, clinic days, Navigate4Me
Includes up to 75% local travel