Requirements
- Knowledge of CMS Regulations and NCQA HEDIS Guidelines
- Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)
- Familiarity with ICD-10 and CPT-4 coding practices
- Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)
- Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements
- Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required
- Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing
- Address and close identified gaps in care (disease-specific or preventive)
- Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and Perform, document and communicate results of Point of Care (POC) Testing
- Maintain compliance with Company policies, procedures and mission statement
- Adhere to all confidentiality and HIPAA requirements as outlined within the Company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
- Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company
- Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function
- On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)
Benefits
- company 401K plan
Work Arrangement
Remote (City/Region)
Additional Information
- In-home visit rate: $120 - $140 depending on state of residence
- If available, our telehealth rate is $85 per completed assessment
- New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.
