Provider Chart Reviewer
About Us
One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn’t your average doctor’s office. We’re on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health networks. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.
In February 2023 we marked a milestone when One Medical joined Amazon. Together, we look to deliver exceptional health care to more consumers, employers, care team members, and health networks to achieve better health outcomes. As we continue to grow and seek to impact more lives, we’re building a diverse, driven and empathetic team, while working hard to cultivate an environment where everyone can thrive.
Medicare Risk Adjustment at One Medical
The Medicare Risk Operations team at One Medical promotes and supports our relentless commitment to deliver the highest quality care to our patients. We support our care team members by providing detailed clinical documentation practices, surfacing diagnoses for provider evaluation, and helping drive clinical decision making. Our mission on the Medicare Risk Operations team is to help our providers document the most accurate and comprehensive medical records possible to deliver high-quality, efficient, evidence-based care to our complex patients.
The Role
This is a fully remote opportunity for a provider who is looking to play a critical role in a high growth, innovative healthcare company. The primary purpose of this position is to help review patient medical records to ensure the most truthful, accurate, and complete clinical documentation is maintained by our providers while signaling potential clinical opportunities to promote comprehensive care. This role reports directly to the Provider Chart Reviewer Manager.
Key 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
Qualifications
- Actively-licensed NP or PA
- Any state license (all state licensure welcome)
- 3+ years clinical practice experience with experience in medical record review/navigation
- Experience with HCC coding practices or Medicare Risk Adjustment preferred
- 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
One Medical providers also demonstrate:
- Experience using innovative technologies including natural language processing, machine learning is preferred but not required
- Able to foster a positive team culture despite a fully remote position
One Medical is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.
One Medical participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Please refer to the E-Verification Poster (English/Spanish) and Right to Work Poster (English/Spanish) for additional information.