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MedPOINT Management (MPM)

Department: Quality Management (QM)

Salary Range: $75,000 - $85,000

Summary

Member of the coding team working with large clinics to improve their HCC coding program as well as improve coding for other quality measures. Desired candidate will be assigned health centers in a specified geographic area and work with each location on a rotating schedule. Educate providers and administrative staff on correct coding and charting as it applies to Medicare Advantage and Covered CA members. Will provide in-services in small and large group settings. Requires driving to Southern CA health centers approximately 90% of the time.

Duties and Responsibilities

  1. Reviews and audits medical records at provider offices/clinics to identify coding risk areas and ensure that training activities are addressing these areas.

  2. Review records for completeness, accuracy and compliance with regulations.

  3. Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.

  4. Using independent judgement and sensitivity, review with individual physicians and clinic administrators their audit findings and make suggestions for coding and documentation improvements.

  5. Provide written documentation of potential HCC codes to providers at the point of care while ensuring accuracy of coding and documentation.

  6. Resolve or clarify codes or diagnoses with conflicting, missing or unclear information by consulting with providers.

  7. Provide expertise in reviewing and assigning accurate medical diagnoses codes for a wide variety of clinical cases based on services performed by physician and other qualified healthcare providers in the office or clinic setting.

  8. Demonstrate sound knowledge of medical coding guidelines and regulations to assist providers and clinic administrators the impact of diagnosis coding on risk adjustment payment models.

  9. Maintain a professional and supportive working relationship with clinic staff, health plan staff, administration and physicians.

  10. Demonstrate high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as a possible source for HCC codes.

  11. Participate in meetings as requested in order to establish and maintain interdepartmental and external partner communication and cooperation.

  12. Work with offices to coordinate completion of Annual Wellness Visits (AWV) for Medicare and Covered CA members.

  13. Work with health centers to build efficient workflows using EHR systems

  14. Identifies training needs; prepares training materials and conducts coaching and training as appropriate for clinic staff, physicians and other staff to improve the quality of the diagnosis documentation and accuracy of the collection and coding of members’ health data

  15. Performs miscellaneous job-related duties as assigned and requested

  16. Provide HEDIS information and resources upon request.

  17. Work with health center quality staff for patient requests on HEDIS needs.

Minimum Job Requirements

  • Bachelor’s Degree or equivalent experience in finance/business, medical records technology, health services administration, nursing or other ancillary medical area.

  • Certification in one of the following: Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and three or more years of coding experience. (within physician practice, health plan, IPA or MSO setting preferred)

Skill and Abilities

  • Strong written and oral communication skills.

  • Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher

  • Demonstrated expertise with CPT, ICD-10-CM, medical anatomy and terminology in assigning accurate diagnosis coding

  • Sound knowledge of medical coding/billing guidelines and regulations including compliance and reimbursement

  • Working knowledge of Medicare risk adjustment principles and audit processes

  • Ability to work under pressure and respond appropriately in all situations

  • Ability to establish and maintain effective working relationships with physicians and staff

  • Willingness to collaborate with peers to enhance teamwork and performance of all Clinic functions

  • Current CA Driver’s license with current auto insurance

  • EZ-CAP® knowledge a plus

  • Knowledge of EMR Navigation a plus

  • Knowledge of HEDIS measures established by NCQA

MedPOINT Management (MPM)

MedPOINT, a large MSO in the San Fernando Valley offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmangement.com

Summary

This position serves as the coordinator to Health Plan Contracting team, supporting both contract negotiation and implementation efforts. Primary responsibility will include obtaining accurate data from internal and external parties necessary for contract negotiations, including but not limited to current membership, funding, shared risk reports, medical procedural coding definitions, etc. Teammate will also be responsible for maintaining the negotiation folders and updating the Smartsheet trackers and other databases pertaining to the negotiations. Other responsibilities may include performing basic funding modeling/analysis, completing ad hoc contracting-related requests, first pass redline / document comparison, collecting necessary information to complete official documents, and administrative tasks, such as scheduling meetings.

Duties and Responsibilities

  1. Obtain accurate information necessary from both internal and external parties for contract negotiation and analysis.
  2. Maintain databases and folders pertaining to negotiations.
  3. Perform basic financial modeling and analysis as needed.
  4. Complete internal ad hoc contracting requests, including researching in various sources to obtain necessary information.
  5. Performing first pass in document redline/comparison.
  6. Collecting necessary information to populate documents.
  7. Perform administrative tasks such as schedule meetings, printing, and mailing documents as necessary.
  8. Other similar tasks and duties to support the functions of the Health Plan Contracting Department.

Minimum Job Requirements

  1. Bachelor's Degree required. Master's degree in Healthcare Administration, JD, or commensurate experience preferred.
  2. Minimum of three years' work experience as a health plan contracts coordinator or familiarity with contracts and health care.
  3. Detail-oriented, organization, planning and coordination skills required.

Knowledge, Skills and Abilities Required

  • Must be an organized self-starter and able to work from home.
  • Excellent communications skills and team-oriented attitude.
  • Excellent working knowledge of Excel, including the ability to perform v-lookup and create pivot tables required.
  • Basic working knowledge of Smartsheets and Adobe Pro and required.
  • Basic working knowledge of Tableau and Power BI preferred.
  • Strong problem solving and analytical ability, ability to troubleshoot.
  • Excellent written and verbal communication and organizational skills.
  • Experience with EZCAP 6x, or other Healthcare management system preferred.

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