Job Description

Position Summary:

The HCC Trainer, Risk Adjustment, is responsible for working under the lead supervision of the Senior. Director and in collaboration with the senior leadership of Risk Adjustment, to maintain, improve, and deliver the best risk adjustment metrics. Coordinates and performs projects/initiatives as delegated by the executive leadership. The HCC Trainer oversees opportunities for assessing risk adjustment needs among the assigned network and accounts for operational and fiscal performance of all providers and partners.

Essential Duties and Responsibilities include the following:

• Audit Provider patient charts and analyze for proper documentation. Also, review all other chart documents to identify potential conditions that the Provider may not have listed.
• Subjective – History of chief complaint or current status of symptoms
• Objective – Results of all examinations
• Assessment – Current and chronic conditions written as stated on the superbill
• Plan – Explanation of treatment.
• Review audit findings with the Provider and provide any substantiating medical background to the findings.
• Ensure that the Provider performs proper follow-up to provide care for the patient as indicated in the audit findings.
• Train and mentor Risk Adjustment staff.
• Accountable for increasing the organization’s Risk Adjustment metrics to place the company within the upper quartile of the industry.
• Experience in chronic condition diagnostic coding, clinical lab results, and pharmacy interactions.
• Serve as the Risk Adjustment lead in interfacing with all levels of management.
• Conducts regular on-site Risk Adjustment training for providers and staff.
• Daily interaction with the direct supervisor on operational needs within the assigned network.
• Assist in the design and implementation of annual Risk Adjustment incentive programs.
• Establish provider relationships and ensure problem resolution.
• Maintain patient confidentiality so that HIPAA compliance is observed at all times.
• Assist with special projects as assigned.
• All other duties as directed by management.

Education and/or Experience:

• Experience in Managed Care
• Clinical experience preferred
• Coding experience or a Master’s is a plus
• Ability to work with all levels of management
• Must have excellent verbal and written communication skills
• Proficient in MS Office programs(i.e., Word, Excel, Outlook, Access, and PowerPoint)
• Must be able to travel within the service area and have a valid state driver’s license and insurance

The pay range for this position at commencement of employment is expected to be between $90,000 - $100,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, the employee will be in an “at-will position,” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest-growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming, and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full-Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physicians' office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

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