firsthand

Medical writer

• Perform prospective, retrospective, and concurrent coding reviews based on evaluations of prior visit documentation, lab results, images, external medical records, payer claims data, and more
• Demonstrate an understanding of complications, comorbidities, case mix and the impact of procedures on the billed record as well as the ability to impart this knowledge to providers and other members of the healthcare team.
• Support pre-visit planning by communicating to firsthand providers individuals’ potential chronic conditions and care gaps with robust and appropriate evidence
• Ensure accurate, timely, and comprehensive clinical documentation to support code capture, including querying providers when these clinical documentation standards are not met
• Support medical records requests when providers require additional information prior to addressing and diagnosing potential conditions
• Work with team leadership to identify chronic condition prevalence trends by individuals’ demographics; identify and execute potential interventions, e.g., ongoing education to firsthand providers and the CDI team, ongoing quarterly retrospective reviews of unaddressed suspects

Part Time – Clinical Documentation Integrity Specialist, CDIS

Vice President

• The VP, Care Model Performance will be responsible for designing, deploying, and consistently refining the clinical model at the core of firsthand’s business as well as shaping clinical strategy.
• Reporting and as a partner to the Chief Clinical Officer (CCO), the VP, Care Model Performance will ensure quality and strong alignment between clinical strategic initiatives developed and implemented, centralized clinical programming, and the care delivered at the market level.
• With the primary objective of delivering best-in-class practices specific to our population served, the VP, Care Model Performance will develop robust care programming informed by evidence as well as data (e.g., claims, internal and external feeds) related to the firsthand population’s utilization patterns, disease burden and unique demonstrated needs, and be accountable for its associated programmatic and organizational outcomes.
• These programs will bolster firsthand’s interdisciplinary field-based and central support teams in their efforts to engage and build trust with members in their local communities, direct members to the most appropriate settings of care when needed, and identify most-needed social determinant interventions.
• firsthand seeks an experienced and motivated candidate excited to build an organization from the ground up, with a passion for - and preferred personal experience with - helping one of the country’s most underserved populations.

Vice President – Care Model Performance

Learning and Development

• Serve as owner of Clinical Onboarding & ongoing training including shadowing, delivering feedback, and coaching on best practices
• Collaborate closely with Clinical Support Team and practicing Clinicians to ensure training aligns with current practices & initiatives
• Support Learning & Development initiatives by leading training sessions for our growing team
• Develop and maintain training materials including guides, online learning content, and instructional materials
• Develop sessions and materials that bring clinical concepts to life for non-clinicians
• Serve as Learning Management Administrator to ensure team members are enrolled in appropriate sessions and monitor completion of training plans
• Coordinate with stakeholders across the organization to develop and implement needed training
• Measure and monitor training effectiveness, and work collaboratively with the L&D Director to evolve programs
• Travel to different communities up to 60% of your time, particularly to launch new markets
• Use data to drive decisions, lead engaging training sessions, and support team members as they grow into and beyond their roles
• Report to the Director of Learning & Development

Training Specialist - Clinical

Billing Specialist

• Become subject matter expert in the capabilities of firsthand's billing systems, including EHR and Clearinghouses
• Appropriately codes services, procedures, diagnoses, and treatments. Verifies that the assignment of International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedural Coding (HCPC) codes are compatible, appropriate, and accurate for billing
• Use medical terminology to understand clinical documentation and determine if it appropriately supports diagnoses. Reviews all individual visit encounters for completeness and accuracy in all services rendered
• Educates firsthand Advance Practice Nurses (APNs), Nurse Practitioners (NPs), and other team members on proper code selection, documentation, procedures, and requirements. Provides technical guidance to APNs, NPs, and other team members in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines
• Prepares and submits claims for payment, and corrects rejected claims
• Advises on ongoing process improvements related to coding and billing. Makes recommendations for changes in policies and procedures, e.g., revising the master CPT list. Develops and updates procedures manuals to maintain standards for correct coding, and to minimize the risk of fraud and abuse

Part Time – Clinical Documentation Integrity Specialist, CDIS

Vice President – Care Model Performance

Training Specialist - Clinical

Coding and Billing Specialist