Columbus, Ohio - Medical Director - Medicare Risk Adjustment HCC Review

Job description

Columbus, Ohio - Medical Director - Medicare Risk Adjustment HCC Review

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.
More information is below!
JOB DESCRIPTION
Medical Director
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:
Duties include, but are not limited, to the following:
Conducts on-site or desktop medical record reviews in tandem with a certified professional coder at provider locations or at company's offices
Facilitates query process to improve clinical documentation to support appropriate reimbursement for the level of service rendered to all patients with (Medicare Advantage)
Educates physicians on clinical documentation opportunities as well as performance improvement methodologies
Maintains thorough and current knowledge of clinical care and treatment of assigned patient populations to critically assess appropriateness of documentation
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
Provides clinical interpretation and guidance to fellow clinicians and internal staff.
Advises manager of possible trends in inappropriate utilization (under and/or over), and other quality of care issues.
Develops and en