HCC Risk Adjustment Trainer

Regal Medical Group•San Bernardino, CA

9d•$90,000 - $100,000•Hybrid

About The Position

The HCC Trainer is responsible for working under the lead supervision of the Chief Financial Officer and in collaboration with the senior leadership of Risk Adjustment to maintain, improve and deliver the best risk adjustment metrics. Coordinates and performs projects/initiatives as delegated by the executive leadership. The HCC Trainer oversees opportunities of assessing risk adjustment needs among the assigned network and accounts for operational and fiscal performance of all providers and partners.

Requirements

Experience in Managed Care
Clinical experience preferred
Coding experience or Master’s a plus
Ability to work with all levels of management
Must have excellent verbal and written communication skills
Proficient in MS Office programs(i.e. Word, Excel, Outlook, Access and Powerpoint)
Must be a able to travel within service area and have a valid state driver’s license and insurance

Nice To Haves

Experience in chronic condition diagnostic coding, clinical lab results and pharmacy interactions.

Responsibilities

Audit Provider patient charts and analyze for proper documentation. Also, review all other chart documents to identify potential conditions that Provider may not have listed.
Subjective – History of chief complaint or current status of symptoms
Objective – Results of all examinations
Assessment – Current and chronic conditions written as stated on superbill
Plan – Explanation of treatment.
Review audit findings with Provider and provide any substantiating medical background to the findings.
Ensure that Provider performs proper follow-up to provide care for the patient as indicated in the audit findings.
Train and mentor Risk Adjustment staff.
Accountable for increasing organization’s Risk Adjustment metrics in order to place company within the upper quartile of the industry.
Serve as the Risk Adjustment lead in interfacing with all levels of management.
Conducts regular on-site Risk Adjustment trainings for providers and staff.
Daily interaction with direct supervisor on operational needs among assigned network.
Assist in design and implementation of annual Risk Adjustment incentive programs.
Establish provider relationships and ensure problem resolution.
Maintain patient confidentiality so that HIPAA compliance is observed at all times.
Assist with special projects as assigned.
All other duties as directed by management.