Description

UPMC Health Plan is seeking a full-time Physician Educator to support the Medicare HCC Risk Adjustment team for the State College territory!

The Physician Educator will work standard hours, Monday through Friday! This role is completely remote with the exception of when visiting clients in the specified territory! Limited travel to visit clients is required, and the ideal candidate will live within approximately 20 miles of the State College area.

The Physician Educator serves as a liaison between the Health Plan and the participating providers of the UPMC Health Plan Network! This role is 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, which includes assessment of learning needs, assessment of workflow processes, and identification of barriers that impact correct coding documentation.

The Physician Educator is responsible for the 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. This role is additionally responsible for distributing provider reports to physicians and practice management staff to assist them in improving their outcomes related to risk adjustment. In addition, the Physician Educator is responsible for evaluating medical record documentation through the medical record review process and providing feedback and recommendations for improvement.

This role will provide feedback to Operations-Risk Adjustment management and will work collaboratively and cooperatively with Network Management, Reimbursement, and other Health Plan departments, as required. It is vital for the Physician Educator to have the ability to build and maintain strong working relationships with providers, as well as to maintain a positive and helpful attitude!

Additional Preferences: Outpatient practice management experience, experience working with physicians and physician practices, ICD-10 coding and medical record documentation knowledge, exceptional presentation and customer service skills, and proficient computer skills (including Excel, Word, Outlook, and Teams).

Responsibilities:

• Develop and maintain collaborative relationships with assigned providers/practices within the UPMC Health Plan 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 current and in-depth knowledge of CMS guidelines related to risk adjustment, coding, and documentation, as well as knowledge of new models of risk adjustment that impact Health Plan revenue.
• Track all educational activities, trends, and patterns of providers/practices.
• Assist practice with the 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 ongoing performances 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 UPMC Health Plan and assist them with identifying strategies that will improve their quality of patient care and maximize risk adjustment revenue.
• Assist the Senior Manager in the 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.

Qualifications

• Bachelor's Degree required, or comparable work experience will be considered.
• Minimum of 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.
• Excellent verbal and written communication, analytical, and organizational skills required.
• Extensive problem-solving experience is required.
• Experience working with physicians and physician practices.
• Goal-oriented and experienced with development and implementation of action plans.
• Excellent customer service required.
• Ability to interact with the public in a diplomatic and tactful manner and ability to 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.

Licensure, Certifications, and Clearances:
Licensure/certification preferred: CCP, CRC, CCS, CPC-P, CPMA, CPPM within 6 months of hire.

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran