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Manager, Risk Adjustment CDI
Location:
Fort Myers, FL
Description:
Summary: The Risk Adjustment (RA) Clinical Documentation Improvement (CDI) Manager reports to the Director of Burden of Illness (BOI). S/he performs duties to conduct the day-to-day supervision of the Risk Team Supervisors and team functions by communicating with other operational departments and provider offices. S/he will participate in the development, implementation, and performance of workflows for auditing electronic medical records aimed at improving the health and well-being of patients through proper identification of chronic disease conditions. This role will collaborate with all areas of the organization to ensure success of our value-based coding initiatives such as provider engagement, education, prevalence rates, documentation compliance and medical margin. He/she will support and further enhance the data and reporting model to capture and optimize ICD-10 reporting to payers to improve quality for our patients and reduce healthcare costs. Essential Duties and Responsibilities Ensure compliance with all applicable federal, state and/or county laws and regulations related to coding and documentation guidelines for risk adjustment. Train and lead staff to review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries 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 identified as being unsubstantiated by the record must be communicated to the carrier within timely guidelines to ensure only supported diagnosis codes remain on record with those carriers. Review for clinical indicators and query providers to capture the severity of illness of the patient. Participate and execute the continued development of provider performance measures on important aspects of care and service through data reviews and data-driven analysis Communicates and coordinates reviews with Quality Program Educators for use in provider training sessions. Manages the BOI Team in a positive manner with emphasis on providing excellent service to all patients, providers, internal and external customers Confirm code capture and proper RAF calculations by carriers and assist with health plan claim/EDS risk adjustment related data submission and reconciliation Oversees reporting for reassessment of chronic conditions, provider address rates, coder variability, and other risk adjustment coding related measure trends Participate in identifying and developing technology to enhance risk adjustment operations and accuracy Provides clear, concise, and professional communication to varying audiences Demonstrates excellent time management, attends, and contributes to required meetings which may include travel as well as hours outside of standard business hours and/or above 40 hours per week Demonstrates the ability to train new leaders or provide ongoing education and training to existing staff/leaders along with regularly performing quality reviews and including feedback on opportunities for improvement to the BOI team Maintains a working knowledge of relevant government and third-party health care initiatives in which the company participates. It is assumed, to maintain these skills, the relevant seminars, books, periodicals, and regulations be routinely reviewed Performs other duties as assigned or requested Supervisory Responsibilities Directly supervises assigned employees in the BOI department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Education and Experience Required Minimum Education/Experience: Bachelor's degree required Active CRC or CPC certification through AAPC Minimum 4 years' experience working in payor or healthcare provider organization Preferred Education/Experience 6+ years of experience working in healthcare provider organization, specifically with roles in value-based care/risk adjustment Project management skills Provider organization knowledge Experience leading teams Experience with CMS-HCC risk adjustment methodologies and reporting guidelines Required Skills and Abilities Attention to detail MS Office, expert knowledge in Excel Critical thinking skills Ability to work with technical and non-technical stakeholders Desire to learn/intellectual curiosity Job Posted by ApplicantPro
Company:
Millennium Physician Group
Posted:
January 25 on ApplicantList
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More About this Listing: Manager, Risk Adjustment CDI
Manager, Risk Adjustment CDI is a Executive Manager Job at Millennium Physician Group located in Fort Myers FL. Find other listings like Manager, Risk Adjustment CDI by searching Oodle for Executive Manager Jobs.
Manager, Risk Adjustment CDI is a Executive Manager Job at Millennium Physician Group located in Fort Myers FL. Find other listings like Manager, Risk Adjustment CDI by searching Oodle for Executive Manager Jobs.