Medicare Risk Adjustment MRA Physician Lead

Profile

Description

CenterWell Senior Primary Care, a subsidiary of Humana Inc., is the new brand for a primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. CenterWell Senior Primary Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience. CenterWell Senior Primary Care has experience in both the treatment and management of most chronic and acute-care conditions. The practices also provide health education and value-added, well-being services at the centers and around their neighborhoods to help both patients and community members improve their health.

At CenterWell Senior Primary Care, we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

Responsibilities

The MRA Physician Lead serves as a health-care professional and capable of handling a variety of health-related problems. The MRA Physician Lead has similar job duties as a Physician, namely focusing on outpatient medicine, continuity of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the patient to specialists as needed.

In addition to clinical responsibilities, the MRA Physician Lead will conduct activities specifically focused on improving Medicare risk adjustment documentation accuracy within his/her specific market. Activities will include but are not limited to the following:

Develop strategies and execute plans to educate providers on coding and documentation accuracy

Conduct chart reviews and 1:1 audit sessions with providers to improve documentation accuracy with a specific focus on new and low performing providers

Meet regularly with coding manager to assess coder progress/concerns in pre-review process

Monthly meeting with coders to provide education on chronic condition clinical indicators and chart review processes to ensure alignment between coders and Providers

Develop and deliver provider trainings on various MRA conditions working with and utilizing resources throughout CDO - Training team, Quality Committee, CDO specialists (ex. Cardiology)

Conduct MRA onboarding training for new providers

Work with CDO quality committee to develop clinical pathways for various high risk conditions

Partner with MRA team to develop/review suspect logic to identify undocumented chronic conditions based on claims and eCW data

Review and analyze MRA data - DBI, HCC/patient, etc. - to identify areas of opportunity for improvement, training, education, etc.

Advises executives to develop functional strategies (often segment specific) on matters of significance.

Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.

The MRA Physician Lead will spend 80% of their time clinically focused on direct patient care, with the remaining 20% of time dedicated to program initiatives.

Required Qualifications

Typically requires Bachelor's degree or equivalent

5 years of technical experience

Licensure requirements of the state of jurisdiction Graduate of accredited MD or DO program of accredited university

Successful completion of an accredited ACGME/AOA Family Medicine/Internal Medicine/Geriatric Medicine residency program

This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Preferred Qualifications Additional Information

Preferred Qualifications

Board Certification or Eligible to become certified (ABMS, AOA or ABPS) in Family Medicine, Internal Medicine or Geriatric Medicine preferred

Additional Information

#PhysicianCareers

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com