Jobs in Springfield, MA

Primary Responsibilities :

• Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members. Will be out in the field 80% of time in defined territory with rare occasion of overnight travel
• Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources
• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and hospitals
• Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding specificity
• Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data / forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract
• Consult with provider groups on gaps in documentation and coding
• Provide feedback on EMR / EHR systems where it is causing issues in meeting CMS standards of documentation and coding
• Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership
• Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
• Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
• Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements
• Provides ICD10 - HCC coding training to providers and appropriate office staff as needed
• Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
• Develops and delivers diagnosis coding tools to providers
• Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
• Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices
• Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
• Assist in collecting charts where necessary for analysis.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :