Clinical Documentation Improvement Manager
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.
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