Provider Chart Reviewer

Summary

Join One Medical's Medicare Risk Operations team as a fully remote Provider Chart Reviewer! This critical role focuses on ensuring accurate and complete clinical documentation in patient medical records. You will review charts, identify potential diagnoses, and collaborate with a team to standardize work. The ideal candidate possesses 3+ years of clinical practice experience, including medical record review and a strong understanding of HCC coding practices. This position offers competitive compensation, comprehensive benefits, and the opportunity to contribute to a high-growth healthcare company. One Medical is committed to providing a positive and supportive work environment.

Requirements

• Actively-licensed NP or PA
• Licensed to practice in AZ
• 3+ years clinical practice experience with experience in medical record review/navigation
• Basic understanding of CMS compliance practices
• Excellent communication skills (written and oral); very strong interpersonal, relationship building skills
• Strong attention to detail but also able to ensure adequate productivity of 4-6 charts per hour (depending on the particular project)
• Ability to work 40 hours per week
• 2 years of experience in Primary Care in most recent 5 years of work experience
• Experience managing and treating a patient panel independently
• Previous experience with complex patients

Responsibilities

• Chart review of patient medical records in a timely fashion (average of 6 charts per hour; depending on the project)
• Evaluate existing issues on the issues list to ensure accurate, detailed documentation and signal to the provider as to whether or not clarification is indicated using existing clinical information to support the clarification
• Explore clinical records for evidence to support surfacing potential suspect diagnoses for treating-provider review
• Navigate complex medical records to identify clinical opportunities using various tools and technologies (between two, proprietary electronic medical records, 1Life and Chirp)
• Work alongside a team of passionate provider chart reviewers and collaborate to ensure standardization of work
• Utilize compliant language and clinically valid rationales to support suspected conditions and clinical recommendations for providers
• Be able to pivot between various special projects due to shifting priorities at the discretion of the Medical Director and team leadership
• Meet once monthly with the other reviewers to discuss projects, organizational news, department initiatives, new processes/systems, and changes to coding policies/guidelines
• Meet regularly with MRO leadership for audit feedback to ensure compliance and productivity goals are met
• Maintain an audit pass rate > 95% on an ongoing basis
• Other duties as assigned

Preferred Qualifications

• Experience with HCC coding practices or Medicare Risk Adjustment
• Experience using innovative technologies including natural language processing, machine learning
• Able to foster a positive team culture despite a fully remote position

Benefits

• Employee Assistance Program - Free confidential advice for team members who need help with stress, anxiety, financial planning, and legal issues
• Competitive Medical, Dental and Vision plans
• Free One Medical memberships for yourself, your friends and family
• PTO cash outs - Option to cash out up to 40 accrued hours per year
• 401K match
• Credit towards emergency childcare
• Company paid maternity and paternity leave
• Paid Life Insurance - One Medical pays 100% of the cost of Basic Life Insurance
• Disability insurance - One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance