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Physician Educator- Health Plan, Remote


UPMC Health Plan is hiring two full-time Physician Educators to help support the Medicare HCC Department. Both roles will be remote, but one candidate should be located in our around Allegheny County and one should be located in or around Indiana County. 

The Physician Educator serves as a liaison between the Health Plan and the participating providers of the UPMC Health Plan Network. The Physician Educator is the primary resource for participating providers to address issues, questions and learning needs related to coding and documentation in the medical record and the various risk adjustment models of payment. The Physician Educator is responsible for education of the participating providers and their staff. This includes assessment of learning needs, assessment of work flow processes and identification of barriers that impact correct coding documentation. The Physician Educator is responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. The Physician Educator distributes provider reports to physicians and practice management staff to assist them in improving their outcomes related to risk adjustment. In addition, the Physician Educator is responsible for evaluating medical record documentation through the audit process and providing feedback and recommendations for improvement. The Physician Educator will provide feedback to Operations-Risk Adjustment management and work collaboratively and cooperatively with Network Management, Reimbursement and other Health Plan department as required. The Physician Educator maintains a positive and helpful attitude as a liaison to the participating providers of the UPMC Health Plan.



  • Identify and document best practices related to coding, documentation and workflow and share with practice administrators and risk adjustment physician educator staff.Collaborate with practices that have entered into shared savings arrangements with UPMC Health Plan and assist them with identifying strategies that will improve their quality of patient care and maximize risk adjustment revenue.
  • Track all educational activities and trends and patterns of providers/practices. Assist practice with integration of correct coding and documentation standards into workflow. Troubleshoot issues that impact the integration of correct coding and documentation and maximization of Health Plan revenue.
  • Assess work flow processes in physician practices that impact the ability to maximize Health Plan revenue achieved through the various risk adjustment payment models.
  • Adhere to CMS coding and documentation guidelines.
  • Identify trends and barriers that interfere with correct coding and documentation practices in the physician practice sites, Including but not limited to work flow, electronic health records and clearinghouses.
  • Analyze and distribute reports to providers that summarize their performance related to coding and documentation and risk Adjustment.
  • Maintain confidentiality of audit results and member information.Maintain a current and in-depth knowledge of CMS guidelines related to risk adjustment and coding and documentation, as well as knowledge of new models of risk adjustment that impact Health Plan revenue.
  • Develop and maintain collaborative relationships with assigned providers/practices within the UPMC Health Plan Network.
  • Coordinate and present education of providers/practices related to risk adjustment, coding and clinical documentation improvement.
  • Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.
  • Develop and implement strategic action plans based on findings of assessment of physician practice work flows and medical record documentation audits.
  • Monitor on-going performance of physicians and practices and report finding to the providers, practice administrators and Risk Adjustment management. Identify sites within the network to offer public education on coding and documentation and provide classes on a regular basis.
  • Assist Senior Manager in development of education objectives and programs. Collaborate with Riaks Adjustment management staff in the development and implementation of the annual HCC prospective campaigns.Collaborates with Network Management, Reimbursement, Claims and other Health Plan departments as required.


Qualifications - Internal

  • Bachelor's Degree required or comparable work experience will be considered
  • Minimum five (5) years of experience in professional services, including practice management, nursing, clinical documentation improvement or quality audit.
  • Two to three (2-3) years of teaching experience in a clinical setting preferred
  • Two to three (2-3) years of progressive leadership experience preferred
  • Prior nursing experience is highly preferred 
  • Extensive knowledge of coding and documentation requirements including ICD-10-CM, CPT-4 and HCPCS
  • In-depth knowledge of medical terminology, anatomy and physiology, pharmacology, and pathology required
  • Excellent verbal and written communication skills, analytical skills and organization skills required
  • Extensive problem-solving experience is required.
  • Experience working with physicians and physician practices
  • Goal-oriented and experience with the development and implementation of action plans.
  • Excellent customer service required.
  • Ability to interact with public in a diplomatic and tactful manner and represent the Health Plan effectively.
  • Ability to manage relationships with assigned practices and maintain records of all activities.
  • Ability to develop action plans as required.
  • Proficient computer skills
  • Self-motivated with the ability to work with minimal supervision

Licensure, Certifications, and Clearances:
Licensure/certification preferred CCP, CRC, CCS, CPC-P, CPMA, CPPM within 6 months of hire

UPMC is an Equal Opportunity Employer/Disability/Veteran



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   Current UPMC employees must apply in HR Direct