Professional Services - Medical Consultant

Position Title: Medical Consultant

Purpose or Reason for the Position: Promotes the success of clients by providing clinical credibility, training of clinicians and others on key aspects of payment methodologies, medical diagnosis, documentation and coding related to health plan management processes and clinical outcomes. Also to help clients analyze challenges in data submission into the Risk Adjustment Processing System and Encounter Data Processing System

Position Reports to: Chief Medical Officer

Primary Functions

1. Under direction of Chief Medical Officer, is responsible to support client organizations effectively to optimize processes related to diagnosis documentation, coding, data management, and related processes that impact revenues
2. Identify deficiencies in client knowledge, skills or attitudes that allow ineffective processes
3. Identify trends or gaps in data and troubleshoot data flow processes
4. Collaborate with Client Success Liaisons to
   • Develop and maintain effective relationships and communications with clients to assure early detection of adverse situations and successful implementation of corrective actions
   • Establish goals for clients as needed for improvements
   • Develop effective corrective action plans with clients
5. Create and modify effective training materials (PowerPoint presentations, written material, video recordings or other media) for clients on relevant topics
6. Provide training to Providers (physicians, nurse practitioners, physician assistants) and other clinically oriented staff members on all aspects of risk adjustment methodologies used in various value-based contracts, basic documentation principles, and Clinical Documentation Excellence.
7. Assist Chief Medical Officer to develop and maintain a curriculum of topics with appropriate support materials to meet client needs for training and education
8. Assist Director of Coding/Auditing Services in training of Nurses to become Nurse Auditors, and in training and onboarding of new Client Service Liaisons.
9. Collaborate with Clinic Service Liaisons, Auditors, and when applicable, coders assigned to a given client to identify issues and challenges to be addressed during an upcoming training webinar with the client’s clinical staff members.
10. Collaborate with CareVention Project Managers coordinating the provision of various CareVention services so that the client receives contracted CareVention services in an orderly and coordinated manner.
11. In concert with CareVention Project Managers, explore and communicate when it’s realized that clients could benefit from more comprehensive CareVention services than currently being employed.
12. Work with the Marketing Department with updated sales material as requested.
13. Responsible to support the organization to further its mission and values, grow market share, and refine existing or develop additional products and services.

• Collaborate with Project Managers during exploratory calls with potential clients. Act as subject matter experts during presentations explaining the scope of Capstone services.
• Review and update reference materials for staff and clients
• Provide articles for website and newsletters
• Represent Capstone well to external organizations
• Support coding and auditing department with medical expertise as required
• In collaboration with other physician consultants and TRHC University, maintain and curate the “On-Line Clinical Documentation Excellence” educational material.
• In collaboration with other physician consultants and TRHC University, create update and maintain video recordings of all Capstone presentations including the four-hour general overview (“survey” presentations) and all specialty specific topics.
• Others duties as assigned or requested.

Education

Required:

• MD or DO
• Board Certified in Internal Medicine or Family Medicine

Preferred:

• Board Certification in Geriatrics
• Board Certification in Hospice and Palliative Care Medicine
• CMD or other medical leadership certification

Experience & Training

Required:

• 3 years’ PACE experience
• Alternatively, 5+ experience in Risk Adjustment Models of Care and deep familiarity of the PACE Model
• Strong analytical skills and good clinical judgment.
• Strong technical skills (to monitor and make suggestions about proprietary system development/enhancements)
• Articulate and comfortable teaching in front of an audience (live or virtual).
  
  
• Must have an physician license in good standing
  
  

Preferred:

• Medical Director or equivalent leadership responsibilities
• Deep understanding of the Annual ICD-10 Coding Guidelines.
• Expertise in the layout of the ICD-10 code books and proficiency in its proper use. Familiarity with CPT, HCPCS coding
• Complete understanding of the CMS Risk Adjustment Payment Model (Medicare Managed Care Manual Chapter 7)
• Moderate competency in Microsoft PowerPoint and Excel applications
• Competency in webinar platforms (e.g. Zoom, Microsoft Teams, GoToMeeting).

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.