Job Description

Medical Director Opportunity Medicare Risk Adjustment HCC Review Puerto Rico (Option to be Florida Based)

Option to either live in Puerto Rico or Florida.

Full-Time Opportunity, M-F 8am - 5pm type hours.

Seeking Board Certified Internal Medicine or Family Medicine Physician. The physician will perform chart reviews, provider education as well as staff education.

Competitive Salary. Full Benefits Package includes: Health Insurance (BCBS), PTO, Holidays, Life Insurance, Disability, IRA with matching (3%), Cell phone reimbursement, Car mileage reimbursement and more.

JOB DESCRIPTION

ROLE: The Medical Director reviews outpatient/inpatient medical records for proper documentation relevant to Medicare Risk Adjustment reimbursement payment system.

REPORTS TO: Chief Medical Officer.

MAJOR JOB DUTIES:

1. Conducts on-site or desktop medical record reviews in tandem with a certified professional coder at provider locations or at company's offices.
2. Facilitates query process to improve clinical documentation to support appropriate reimbursement for the level of service rendered to all patients with Medicare Advantage.
3. Educates physicians on clinical documentation opportunities as well as performance improvement methodologies.
4. Maintains thorough and current knowledge of clinical care and treatment of assigned patient populations to critically assess appropriateness of documentation.
5. Receives, reviews, verifies, and processes requests for medical record audits, including but not limited to, inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims.
6. Provides clinical interpretation and guidance to fellow clinicians and internal staff.
7. Advises manager of possible trends in inappropriate utilization (under and/or over), and other quality of care issues.
8. Develops and ensures compliance with policies, procedures, bylaws, regulatory requirements, and best practice guidelines.
9. Review of quantitative and qualitative data in developing plans to achieve goals.
10. Performs other work related duties and responsibilities as directed, assigned or requested.

SKILLS:

1. Demonstrates knowledge of documentation opportunities and clinical documentation requirements.
2. Excellent interpersonal and communication skills.
3. Solid time management skills, including the ability to manage multiple activities and competing priorities.
4. Identifies new innovations to streamline procedures and implements technologies to improve efficiency to ensure high standards of care.
5. Exceptional writing skills and computer proficiency (especially MS Excel).
6. Evidence of completion of formal course in coding principles or equivalent program that includes knowledge of ICD-9 CM coding systems preferred.

EXPERIENCE:

1. Minimum five (5) years practice experience.
2. Medicare Advantage revenue experience strongly preferred.
3. Health care practice experience providing services to Medicare Advantage and Medicaid patients.
4. Significant experience with exposure to the Managed Care environment.

EDUCATION:

1. Medical Doctor Degree or Doctor of Osteopathic Medicine.
2. Advanced degree such as MBA, MHA, MPH or MMM preferred but NOT required.

CERTIFICATE/LICENSE:

1. Board certified in Internal Medicine or Family Medicine (with or without subspecialty boards).
2. Retired or Licensed/Unlicensed.

PHYSICAL, ENVIRONMENTAL & OTHER REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office or medical clinic environment. Must be tolerant to varying conditions of noise level, temperature, illumination and air quality. The noise level in the work environment is usually moderate. Contact with executives, doctors, clinic staff, and other employees is necessary. Requires standing and mobility. Requires bending and reaching. Requires transporting, pushing, pulling, and maneuvering items weighing up to 25 lbs. Requires eye/hand coordination. Requires use of standard office equipment. Requires basic math. Ability to push and/or pull file cabinet drawers weighing up to 5 lbs. Requires the ability to distinguish letters, numbers and symbols. Ability to and comply with Policies and Procedures, Job Description, daily memorandums, chemical labels (MSDS) and other instructions.

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