Physician Educator HPL- Hybrid

The Physician Educator serves as a liaison between the Health Plan and the participating providers of the UPMC Health Plan Network. The Physician Educator is the primary resource for participating providers to address issues, questions, and learning needs related to coding and documentation in the medical record and the various risk adjustment models of payment. The Physician Educator is responsible for educating the participating providers and their staff. This includes the assessment of learning needs, assessment of workflow processes, and the identification of barriers that impact correct coding documentation. The Physician Educator is responsible for the implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. The Physician Educator distributes provider reports to physicians and practice management staff to assist them in improving their outcomes related to risk adjustment. In addition, the Physician Educator is responsible for evaluating medical record documentation through the medical record review process and providing feedback and recommendations for improvement. The Physician Educator will provide feedback to Operations-Risk Adjustment management and work collaboratively and cooperatively with Network Management, Reimbursement, and other Health Plan departments as required. The Physician Educator maintains a positive and helpful attitude as a liaison to the participating providers of the UPMC Health Plan.

The Physician Educator will operate in a hybrid work structure, which includes travel to physician offices in Erie and the surrounding counties. Additionally, this role may require travel to the Pittsburgh office located at 600 Grant Street as needed.

Responsibilities:

• Develop and maintain collaborative relationships with assigned providers/practices within the UPMC Health Plan Network.
• Coordinate and present education of providers/practices related to risk adjustment, coding, and clinical documentation improvement.
• Assess workflow processes in physician practices that impact the ability to maximize Health Plan revenue achieved through the various risk adjustment payment models.
• Identify trends and barriers that interfere with correct coding and documentation practices in the physician practice sites, including but not limited to workflow, electronic health records, and clearinghouses.
• Adhere to CMS coding and documentation guidelines.
• Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
• Analyze and distribute reports to providers that summarize their performance related to coding and documentation and risk adjustment.
• Develop and implement strategic action plans based on findings of assessment of physician practice workflows and medical record documentation reviews.
• Maintain confidentiality of chart review results and member information. Maintain a current and in-depth knowledge of CMS guidelines related to risk adjustment, coding, documentation, as well as knowledge of new models of risk adjustment that impact Health Plan revenue.
• Track all educational activities and trends and patterns of providers/practices. Assist practice with integration of correct coding and documentation standards into workflow. Troubleshoot issues that impact the integration of correct coding and documentation and maximization of Health Plan revenue.
• Monitor on-going performance of physicians and practices and report findings to the providers, practice administrators, and Risk Adjustment management. Identify sites within the network to offer public education on coding and documentation and provide classeson a regular basis.
• Identify and document best practices related to coding, documentation, and workflow and share with practice administrators and risk adjustment physician educator staff. Collaborate with practices that have entered into shared savings arrangements with UPMC Health Plan and assist them with identifying strategies that will improve their quality of patient care and maximize risk adjustment revenue.
• Assist Senior Manager in development of education objectives and programs. Collaborate with Risk Adjustment management staff in the development and implementation of the annual Risk Adjustment prospective campaigns. Collaborates with Network Management, Reimbursement, Claims, and other Health Plan departments as required.