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Clinical Documentation Improvement Manager

  • R0007771
  • Corporate Office

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Job Description
The Manager, High Risk Disease Detection (HRDD) Strategies is responsible for supporting the company Risk Adjustment program and ensuring that risk exposures and opportunities are identified with the key objective of optimizing revenue integrity and accuracy. The Manager, HRDD Strategies works to improve patient health and reduce hospital sick days by ensuring quality and accuracy of diagnoses and coding through education of clinical providers and maximizing of operational practices.  Independently prioritizes center visits based on where improvement is most needed.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

  • Educates individual physicians in staff model centers as well as independent Managed Services Organization (MSO) clients on coding guidelines and appropriate Risk Adjustment procedures.
  • Hires, trains and coaches High Risk Disease Detection (HRDD) managers and specialists as assigned by market; provides guidance in their daily activities. 
  • Works closely with clinical leadership to make sure coding standards are met and there is maximization of appropriate and accurate coding, as well as prevention of inappropriate coding.
  • Assists director in the development of global and individual market strategies to assist in accuracy of diagnoses.
  • Educates clinicians on documentation requirements to comply with CMS standards.
  • Develops educational material as needed to target identified gaps.  Reviews internal educational materials to ensure they are up to date; collaborates with Learning and Development when changes are necessary.
  • Assists in education and transition with onboarding new providers, optimally within their first month.
  • Stays abreast of CMS updated requirements and notifies Information Technology so that dashboard can reflect the changes.
  • Facilitates informing corporate teams on market situations. Assists in analyzing and presenting data to stakeholders.
  • Works with Business Intelligence and IT to develop automated solutions and suggestions to improve documentation.
  • Attends market leadership meetings as needed to coordinate needs and expectations.
  • Collaborates with data teams to identify any potential gaps related to Risk Adjustment.
  • Performs other duties as assigned and modified at manager’s discretion.
Additional Job Description

KNOWLEDGE, SKILLS AND ABILITIES:

  • Use of independent judgement to discreetly manage and impart confidential information
  • In depth understanding of Medicare Risk Adjustment, compliance and requirements, and coding guidelines
  • Understanding of clinical disease definitions and guidelines for identification
  • Ability to develop and maintain relationships that build trust; work with and effectively educate clinical providers (Physicians, Specialists, ARNPs, PAs)
  • Experience developing, implementing, maintaining and revising policies/procedures as well as training materials
  • Ability to educate and influence clinical leaders, presenting complex data clearly and concisely
  • Ability to work with multiple departments and critically evaluate for process improvements related to coding and billing for improved Risk Adjustment
  • Effective communication skills to converse and collaborate with clinicians and other company leadership to produce quality results
  • Comfortable in giving group presentations
  • Proficient in Microsoft Office Suite products including Excel, Word, and Outlook, or other word-processing, spreadsheet, database, e-mail and presentation software as well as EMR and reporting systems
  • General knowledge of HEDIS/Stars guidelines
  • Strong business acumen and experience in data analytics
  • Demonstrated ability to work independently or as part of a collaborative team
  • Ability and willingness to travel locally, regionally and nationwide up to 50% of the time
  • Spoken and written fluency in English

EDUCATION AND EXPERIENCE CRITERIA:

·         Bachelor’s Degree, foreign equivalent accepted

·         Requires Medical Degree, foreign accreditation accepted

·         Minimum of four (4) years’ experience in collaborating with, and influencing, providers in the medical field may substitute for degree

·         Certified Professional Coder and/or Certified Medical Record Auditor and/or Certified Risk Coder required (AAPC or AHIMA); Clinical Documentation Specialist preferred

·         Experience working in a clinical setting (e.g. MA, BSN, RN, RT, sonographer), directly or indirectly with patients

·         A minimum of five (5) years’ work experience in Medical Coding and Medicare Advantage as well as experience in a managed care or medical insurance setting

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