Director, Provider Education & Risk Adjustment

Overview

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.The Physician Educator serves as a liaison between the Health Plan and the participating providers. They are 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. This includes assessment of learning needs, assessment of workflow processes and identification of barriers that impact correct coding documentation. They are responsible for 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. The Physician Educator distributes provider reports to physicians and practice management staff to assist them in improving their outcomes related to risk adjustment. In addition, they are responsible for evaluating medical record documentation through the medical record review process and providing feedback and recommendations for improvement. They will provide feedback to Operations-Risk Adjustment management and work collaboratively and cooperatively with Network Management, Reimbursement and other Health Plan department as required. The Physician Educator maintains a positive and helpful attitude as a liaison to the participating providers of Elderplan.

This is a full-time position working Monday through Friday at variable daytime hours.  This will be a position based in NY requiring 50-75% travel primarily in the 5 boroughs, and surrounding areas as needed. 

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

•    Develop and maintain collaborative relationships with assigned providers/practices within Elderplan 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 a current and in-depth knowledge of CMS guidelines related to risk adjustment, coding, documentation, as well as knowledge of new models of risk adjustment that impact Health Plan revenue.•    Track all educational activities and trends and patterns of providers/practices.•    Assist practice with integration of correct coding and documentation standards into workflow.•    Troubleshoot issues that impact the integration of correct coding