Clinical Educator, Risk Adjustment
Responsible for the delivery and implementation of all clinical education materials and initiatives to employed and contracted providers, as well as KPIs within their region designed to ensure appropriate practices related to risk adjustment activities, HEDIS measures, and any appropriate gaps in care.
The Clinical Educator is also responsible for overseeing the work of the Physician Chart Reviews to inform primary care providers of potential inferred, embedded, out of date, inaccurate, and/or missed diagnoses not previously identified, and aid in the education and discovery of opportunities for improved quality of care and compliance through accurate coding and documentation. The Clinical Educator is further responsible for keeping up to date on changes in the Medicare risk adjustment model or other documentation requirements.
The Clinical Educator works collaboratively with the Regional Medical Director, Risk Adjustment program director, other Clinical Educators, coding department, lead physicians, site administrators, primary care physicians, specialists, surgeons, and hospitalists to educate on and improve accurate coding and documentation skills, leading to a more complete patient record.
- Be accountable for the overall improvement and performance in risk adjustment, HEDIS and any appropriate gaps in care metrics.
- Serve as a resource for the region, network, and national operations on proper coding and documentation.
- Recommends ongoing chart review process to ensure continued high standards in documentation and coding.
- Oversees the Physician Chart Review Team.
- Responsible for onboarding, ongoing, and targeted education of all physicians on coding and documentation for Medicare risk adjustment.
- Creates and modifies the curriculum for mentoring, small group education, and large group education sessions.
- Provides education to employed and contracted physicians, PAs, and ARNPs on appropriate supporting documentation, assists in workflow development when requested, and ensures compliant documentation standards are met.
- 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.
- Meet regularly with Regional Risk Adjustment Physician Director and send updates on activities weekly to network risk adjustment leadership and clinical operations teams.
- Assist Risk Adjustment Director in meeting compliance and regulatory standards.
- Implements 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, coordination of random targeted documentation audits, and concurrent follow up feedback.
- Meets with Regional Medical Director to assist in identification of operational and clinical best practices in maximizing patient visits, re-evaluation of rates, and accurate and proper coding. Assists in the dissemination of best practices to sites, clinicians, and the IPAs providers / support staff.
- Engages clinicians on continuous dialogue regarding optimizing coding, documentation, and associated workflows.
- Maintains knowledge regarding year over year changes to risk adjustment model. Assists in the sharing of best practices related to risk adjustment activities with other regions within the network.
- Attends courses as needed to improve/maintain current up to date knowledge of coding and documentation Integrates learning into chart review processes.
- Attends training to meet requirements of the job position and as needed or mandated by company policies, Div. of Occupational Safety & Health (DOSH), OSHA, L&I and other state/federal regulations.
- Attends and participates as requested in regional and corporate meetings that pertain to coding and documentation.
- Performs additional duties as assigned.
Knowledge / Skills / Abilities:
- Excellent range of knowledge with respect to the practice of medicine.
- Consistently exhibits behavior and communication skills that demonstrate Optum s commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.
- Ability to work independently, analyze and interpret data.
- Advanced computer skills. Knowledgeable in Microsoft word, Excel and PowerPoint.
- Minimum five years experience as a primary care physician, NP or PA.
- Experience in Risk Adjustment coding and documentation clinician education and chart review and documentation inside an Electronic Medical Record (EMR).
- Minimum qualifications include an advanced degree as a MD, DO, NP, or PA.
- Current and unrestricted license to practice medicine in Colorado required.
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