Practice Transformation Specialist
Palm Beach Accountable Care Organization · Houston, TX · 1 mo ago
On-siteOTHRFull-time
We need to produce HTML fragment with headings for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes many responsibilities/duties, qualifications, competencies, etc. No explicit Benefits, Pay, Schedule mentioned. So we should not include those sections. We need sections: maybe "Responsibilities" (Essential Duties and Responsibilities), "Qualifications" (Education and/or Experience, etc.), "Skills" (Computer Skills, Other Skills and Abilities, Competencies). Could also have "About the role" maybe not present; but we could include a brief summary? The instruction: do not repeat job title as heading; we can include About the role if there is a summary. The posting starts with "Summary:" then list of duties. That could be considered About the role? But they said use
for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. The posting includes many responsibilities/duties, qualifications, competencies, etc. No explicit Benefits, Pay, Schedule mentioned. So we should not include those sections. We need sections: maybe "Responsibilities" (Essential Duties and Responsibilities), "Qualifications" (Education and/or Experience, etc.), "Skills" (Computer Skills, Other Skills and Abilities, Competencies). Could also have "About the role" maybe not present; but we could include a brief summary? The instruction: do not repeat job title as heading; we can include About the role if there is a summary. The posting starts with "Summary:" then list of duties. That could be considered About the role? But they said use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). We should include sections only when posting has real specific content. The posting includes "Essential Duties and Responsibilities:" which is responsibilities. Also includes "Qualifications:" section. Also includes "Competencies:" maybe could be under Skills or Requirements. Also includes "Other Skills and Abilities:" etc. Could combine into Skills. Also includes "Physical Demands:" maybe not a standard heading; but we could include under Requirements? Not sure. The instruction: Prefer a few substantive sections over many thin ones. So we could have sections: Responsibilities, Qualifications, Skills. Possibly also Requirements (but Qualifications covers). Could also include "Competencies" as part of Skills. We'll output:
Responsibilities
... list items each duty.
We need to preserve ALL substantive information; do not invent or summarize away detail. So we need to list each duty as separate - . The responsibilities list is long; we need to break into items. Must not lose any detail. We'll need to parse the text and create list items for each sentence or clause separated by periods? The instruction: Use
- for any list of duties/requirements/benefits. So we should convert the responsibilities paragraph into list items. Each duty is separated by periods; we can split at each sentence that starts with a verb. We'll need to be careful to keep all info.
Similarly for Qualifications: we have Education and/or Experience, Language Skills, Reasoning Ability, Computer Skills, Other Skills and Abilities, Physical Demands. Could treat each as sub-items under Qualifications? Or we could have separate sections: Qualifications and Skills. But we already have Skills section for computer skills etc. Let's decide:
Section Responsibilities: list all duties.
Section Qualifications: list Education and/or Experience, Language Skills, Reasoning Ability.
Section Skills: list Computer Skills, Other Skills and Abilities, Competencies (maybe), Physical Demands? Physical Demands maybe not skill but could be under Requirements. But we have no Requirements section; we could put Physical Demands under Qualifications? Might be better to have a Requirements section for physical demands. However instruction: include a section ONLY when posting has real specific content for it. Physical Demands is specific content. So we could have a Requirements section for Physical Demands. But we already have Qualifications; maybe we can combine. However to avoid many thin sections, we could put Physical Demands under Qualifications as a bullet.
But we also have Competencies list; could be under Skills.
Thus final sections: Responsibilities, Qualifications, Skills.
Now we need to extract each bullet.
Let's copy the responsibilities text:
"Essential Duties and Responsibilities: Manage established physician network for business development through system integration and trouble shooting. Work closely with the company business partners and to plan and execute a winning healthcare network strategy. Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems. Analyzes workflow by observing customer operations for three days and configures system to the customer’s workflow. Maps customer’s data from current system to new EHR system. Develops customized training plan complying with regulations and practices of physician specialty, state, third party, etc. Conducts major training programs which may contain a number of different subject modules requiring the coordination of inter- and intra-organization resources. Provides guidance and direction to less experienced educators regarding training and technical problems. Works in a collaborative effort directly with physicians and their office staff to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the position is to collect and review documents to support quality and risk adjustment initiatives, which results in improving quality of care, support to contracted health plans in achieving cost saving opportunities. Stay current on all insurance policy requirement guidelines and active CPT/HCPCS/ICD-10 codes for all payers relevant to the addiction industry. This will be an ongoing effort. Assist with billing claims and collection efforts, as needed Create test studies and pilot programs for various coding strategies in effort to maximize reimbursement within all clinical requirements. Analyze payments & denial reports for trends Assist in daily reporting and analytics on assigned clients. The ideal candidate will have expert knowledge and experience in Microsoft Excel with the ability to perform financial analysis through pivot tables and trend analysis. * Monitors team results to ensure they are aligned with departmental goals. Participates in special projects and performs other duties as assigned. Present coding guidelines to management and clients, as needed Predict industry trends Current CPC; experience in coding and has current knowledge and experience with the active changes in Accountable Care or Medicare Advantage industry. Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis. * Convey a strong professional image, exhibit interest and positive attitude toward all assigned work. * Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Review provider documentation to assure the appropriate E&M levels are assigned correctly. Determine the final diagnoses and procedures stated by the provider are valid and complete. Follow coding guidelines to ensure compliance with Federal and State regulations. Communicate effectively with providers and other support staff. Daily verification of insurance eligibility and benefit information. Answer patient questions regarding claims and billing matters. Assist with the posting of insurance and patient payments. Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe. Any diagnosis code that is unsubstantiated by the record should be eliminated. Review for clinical indicators and query providers to capture the severity of illness of the patient. Orients new providers and monitors their documentation and self-coding until they meet quality standards. Provides instruction to providers and staff in abstracting codes effectively from medical records to ensure quality and timely care of our members as well as correct reimbursement. Communicates with physicians and office staff on education for risk adjustment. Conducts medical charts and claims audits, identifying opportunities for improving individual member risk adjustment score accuracy. Must abide to all HIPAA, Confidentiality and Privacy laws. Handles customers concerns in a helpful and objective manner. Must assist in maintaining area organized, clean. Effectively present and manage the unique benefits of company products and services to physician offices. Other duties as assigned by your Supervisor and Managers. Other duties as assigned Supervisory Responsibilities: This job has no supervisory responsibilities."
We need to split into list items. Many sentences start with verbs. We'll create
- for each distinct duty.
Let's list them:
1. Manage established physician network for business development through system integration and trouble shooting.
2. Work closely with the company business partners and to plan and execute a winning healthcare network strategy.
3. Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems.
4. Analyzes workflow by observing customer operations for three days and configures system to the customer’s workflow.
5. Maps customer’s data from current system to new EHR system.
6. Develops customized training plan complying with regulations and practices of physician specialty, state, third party, etc.
7. Conducts major training programs which may contain a number of different subject modules requiring the coordination of inter- and intra-organization resources.
8. Provides guidance and direction to less experienced educators regarding training and technical problems.
9. Works in a collaborative effort directly with physicians and their office staff to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities.
10. A major focus of the position is to collect and review documents to support quality and risk adjustment initiatives, which results in improving quality of care, support to contracted health plans in achieving cost saving opportunities.
11. Stay current on all insurance policy requirement guidelines and active CPT/HCPCS/ICD-10 codes for all payers relevant to the addiction industry.
12. This will be an ongoing effort.
13. Assist with billing claims and collection efforts, as needed.
14. Create test studies and pilot programs for various coding strategies in effort to maximize reimbursement within all clinical requirements.
15. Analyze payments & denial reports for trends.
16. Assist in daily reporting and analytics on assigned clients.
17. The ideal candidate will have expert knowledge and experience in Microsoft Excel with the ability to perform financial analysis through pivot tables and trend analysis. (This seems more like a qualification; but it's in responsibilities paragraph. We'll keep as duty? Might be better to move to Qualifications. However instruction: preserve ALL substantive information; we can keep it where it appears. It's a sentence about ideal candidate; could be considered qualification. But we can keep it under Responsibilities as a bullet; but it's odd. Might be better to treat as part of Qualifications. However we need to not invent sections; we can keep it under Qualifications. Since we have a Qualifications section, we can move that sentence there. But we must not lose info. We'll extract it to Qualifications.
18. Monitors team results to ensure they are aligned with departmental goals.
19. Participates in special projects and performs other duties as assigned.
20. Present coding guidelines to management and clients, as needed.
21. Predict industry trends.
22. Current CPC; experience in coding and has current knowledge and experience with the active changes in Accountable Care or Medicare Advantage industry. (Again qualification-ish)
23. Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
24. Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
25. Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
26. Review provider documentation to assure the appropriate E&M levels are assigned correctly.
27. Determine the final diagnoses and procedures stated by the provider are valid and complete.
28. Follow coding guidelines to ensure compliance with Federal and State regulations.
29. Communicate effectively with providers and other support staff.
30. Daily verification of insurance eligibility and benefit information.
31. Answer patient questions regarding claims and billing matters.
32. Assist with the posting of insurance and patient payments.
33. Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
34. Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
35. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
36. Any diagnosis code that is unsubstantiated by the record should be eliminated.
37. Review for
Responsibilities
- ... list items each duty.
We need to preserve ALL substantive information; do not invent or summarize away detail. So we need to list each duty as separate
- . The responsibilities list is long; we need to break into items. Must not lose any detail. We'll need to parse the text and create list items for each sentence or clause separated by periods? The instruction: Use
- for any list of duties/requirements/benefits. So we should convert the responsibilities paragraph into list items. Each duty is separated by periods; we can split at each sentence that starts with a verb. We'll need to be careful to keep all info. Similarly for Qualifications: we have Education and/or Experience, Language Skills, Reasoning Ability, Computer Skills, Other Skills and Abilities, Physical Demands. Could treat each as sub-items under Qualifications? Or we could have separate sections: Qualifications and Skills. But we already have Skills section for computer skills etc. Let's decide: Section Responsibilities: list all duties. Section Qualifications: list Education and/or Experience, Language Skills, Reasoning Ability. Section Skills: list Computer Skills, Other Skills and Abilities, Competencies (maybe), Physical Demands? Physical Demands maybe not skill but could be under Requirements. But we have no Requirements section; we could put Physical Demands under Qualifications? Might be better to have a Requirements section for physical demands. However instruction: include a section ONLY when posting has real specific content for it. Physical Demands is specific content. So we could have a Requirements section for Physical Demands. But we already have Qualifications; maybe we can combine. However to avoid many thin sections, we could put Physical Demands under Qualifications as a bullet. But we also have Competencies list; could be under Skills. Thus final sections: Responsibilities, Qualifications, Skills. Now we need to extract each bullet. Let's copy the responsibilities text: "Essential Duties and Responsibilities: Manage established physician network for business development through system integration and trouble shooting. Work closely with the company business partners and to plan and execute a winning healthcare network strategy. Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems. Analyzes workflow by observing customer operations for three days and configures system to the customer’s workflow. Maps customer’s data from current system to new EHR system. Develops customized training plan complying with regulations and practices of physician specialty, state, third party, etc. Conducts major training programs which may contain a number of different subject modules requiring the coordination of inter- and intra-organization resources. Provides guidance and direction to less experienced educators regarding training and technical problems. Works in a collaborative effort directly with physicians and their office staff to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the position is to collect and review documents to support quality and risk adjustment initiatives, which results in improving quality of care, support to contracted health plans in achieving cost saving opportunities. Stay current on all insurance policy requirement guidelines and active CPT/HCPCS/ICD-10 codes for all payers relevant to the addiction industry. This will be an ongoing effort. Assist with billing claims and collection efforts, as needed Create test studies and pilot programs for various coding strategies in effort to maximize reimbursement within all clinical requirements. Analyze payments & denial reports for trends Assist in daily reporting and analytics on assigned clients. The ideal candidate will have expert knowledge and experience in Microsoft Excel with the ability to perform financial analysis through pivot tables and trend analysis. * Monitors team results to ensure they are aligned with departmental goals. Participates in special projects and performs other duties as assigned. Present coding guidelines to management and clients, as needed Predict industry trends Current CPC; experience in coding and has current knowledge and experience with the active changes in Accountable Care or Medicare Advantage industry. Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis. * Convey a strong professional image, exhibit interest and positive attitude toward all assigned work. * Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Review provider documentation to assure the appropriate E&M levels are assigned correctly. Determine the final diagnoses and procedures stated by the provider are valid and complete. Follow coding guidelines to ensure compliance with Federal and State regulations. Communicate effectively with providers and other support staff. Daily verification of insurance eligibility and benefit information. Answer patient questions regarding claims and billing matters. Assist with the posting of insurance and patient payments. Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe. Any diagnosis code that is unsubstantiated by the record should be eliminated. Review for clinical indicators and query providers to capture the severity of illness of the patient. Orients new providers and monitors their documentation and self-coding until they meet quality standards. Provides instruction to providers and staff in abstracting codes effectively from medical records to ensure quality and timely care of our members as well as correct reimbursement. Communicates with physicians and office staff on education for risk adjustment. Conducts medical charts and claims audits, identifying opportunities for improving individual member risk adjustment score accuracy. Must abide to all HIPAA, Confidentiality and Privacy laws. Handles customers concerns in a helpful and objective manner. Must assist in maintaining area organized, clean. Effectively present and manage the unique benefits of company products and services to physician offices. Other duties as assigned by your Supervisor and Managers. Other duties as assigned Supervisory Responsibilities: This job has no supervisory responsibilities." We need to split into list items. Many sentences start with verbs. We'll create
- for each distinct duty. Let's list them: 1. Manage established physician network for business development through system integration and trouble shooting. 2. Work closely with the company business partners and to plan and execute a winning healthcare network strategy. 3. Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems. 4. Analyzes workflow by observing customer operations for three days and configures system to the customer’s workflow. 5. Maps customer’s data from current system to new EHR system. 6. Develops customized training plan complying with regulations and practices of physician specialty, state, third party, etc. 7. Conducts major training programs which may contain a number of different subject modules requiring the coordination of inter- and intra-organization resources. 8. Provides guidance and direction to less experienced educators regarding training and technical problems. 9. Works in a collaborative effort directly with physicians and their office staff to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. 10. A major focus of the position is to collect and review documents to support quality and risk adjustment initiatives, which results in improving quality of care, support to contracted health plans in achieving cost saving opportunities. 11. Stay current on all insurance policy requirement guidelines and active CPT/HCPCS/ICD-10 codes for all payers relevant to the addiction industry. 12. This will be an ongoing effort. 13. Assist with billing claims and collection efforts, as needed. 14. Create test studies and pilot programs for various coding strategies in effort to maximize reimbursement within all clinical requirements. 15. Analyze payments & denial reports for trends. 16. Assist in daily reporting and analytics on assigned clients. 17. The ideal candidate will have expert knowledge and experience in Microsoft Excel with the ability to perform financial analysis through pivot tables and trend analysis. (This seems more like a qualification; but it's in responsibilities paragraph. We'll keep as duty? Might be better to move to Qualifications. However instruction: preserve ALL substantive information; we can keep it where it appears. It's a sentence about ideal candidate; could be considered qualification. But we can keep it under Responsibilities as a bullet; but it's odd. Might be better to treat as part of Qualifications. However we need to not invent sections; we can keep it under Qualifications. Since we have a Qualifications section, we can move that sentence there. But we must not lose info. We'll extract it to Qualifications. 18. Monitors team results to ensure they are aligned with departmental goals. 19. Participates in special projects and performs other duties as assigned. 20. Present coding guidelines to management and clients, as needed. 21. Predict industry trends. 22. Current CPC; experience in coding and has current knowledge and experience with the active changes in Accountable Care or Medicare Advantage industry. (Again qualification-ish) 23. Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis. 24. Convey a strong professional image, exhibit interest and positive attitude toward all assigned work. 25. Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. 26. Review provider documentation to assure the appropriate E&M levels are assigned correctly. 27. Determine the final diagnoses and procedures stated by the provider are valid and complete. 28. Follow coding guidelines to ensure compliance with Federal and State regulations. 29. Communicate effectively with providers and other support staff. 30. Daily verification of insurance eligibility and benefit information. 31. Answer patient questions regarding claims and billing matters. 32. Assist with the posting of insurance and patient payments. 33. Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment. 34. Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting. 35. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe. 36. Any diagnosis code that is unsubstantiated by the record should be eliminated. 37. Review for