- Responsible for the execution and daily management of the CDI provider incentive programs while, providing leadership and participation in risk meetings as an active member of the team, to discuss policy, strategy, implementation, administration, goals, progress, and improvement of the risk program.At times with other key stakeholders in the organization.
- Manage and design productivity standards for coding outpatient encounters completed in Epic.
- Works with compliance, finance, and Quality to ensure compliance with CMS rules and regulations in order to prepare for Rist Adjustment Data Validation (RADV) audits.
- Lead creation of PHSO RADV program policies and procedures.
- Responsible for education of provider groups on all clinical aspects of risk adjustment including completion of annual wellness visits, and coordinates with the RAF Coding team for evaluation and management of chronic conditions, and identification and documentation of all risk adjustable conditions both historical and suspected conditions.
- Serves as RAF Coding Subject Matter Expert (SME) in meetings.
- Responsible to comply with State Medicaid and CMS regulations with respect to Risk Adjustment rules and working with outside vendors to ensure their compliance.
- Must reside in Florida.
- Expert level knowledge of all risk adjustment methodologies.
- Expert level knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, compliance audit concepts
- Knowledge of regulations related to data submission for Medicare Advantage, MMP, and Marketplace risk adjustment.
- Knowledge of CMS response files including RAPS, RAPS returns, MAO-002, MAO-004, as well as RAPS and EDPS submission formats and file protocols
- EDUCATION AND EXPERIENCE REQUIRED :
- Minimum seven years of experience in RAF coding
- 3 years experience as a manager/supervisor
- Bachelors degree in business, health care, or related field. Minimum seven years of experience in RA EXPERIENCE PREFERRED:
- Masters degree in business, health care, or related field.
- LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED :
- CDIP, CCDS or CPC (Clinical Documentation Improvement Practitioner/Certified Clinical Documentation Specialist/Certified Professional Coder) AND EITHER
- LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
- An RN, RHIA, RHIT, MD or DO and two (2) years of experience as a concurrent or retrospective documentation specialist
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Senior Manager Clinical Documentation Integrity - Maitland, United States - AdventHealth PHSO Resources
1 week ago
Description
All the benefits and perks you need for you and your family:
Benefits from Day One
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift : Monday-Friday
Job Location : 2600 Lucien Way, Maitland, 32751
The role youll contribute:
The Population Health Services Organization (PHSO) Senior Manager of Clinical Documentation Integrity (CDI) will be responsible to manage, build provider incentive programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical Documentation Integrity Program. This will include but not be limited to developing the overall structure and operations to support programs in Risk Adjustment coding, CDI review, working on Electronic Medical Record tools, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and economic outcomes. Ensure that risk adjustment related programs are performing and compliant and in all regulatory mandated and contractual activities. Monitor key program and population metrics, as well as participate in process improvement efforts serving as a risk adjustment coding resource for network physicians, PHSO committees, members, medical services, health management, and member service staffs as well as other internal and external partners. Responsible for actively identifying opportunities of improvement and developing and driving annual clinical initiatives related to the risk adjustment coding management for the populations served. Risk Adjustment Factor (RAF) topic educator and training resource to population health services and programs to PHSO and Integrated delivery system partners. Additionally, responsible for reviewing and identifying any opportunities in coding policies and procedures and providing clinical and economic data necessary to make recommendations.
The value youll bring to the team:
Qualifications
The expertise and experiences youll need to succeed:
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.
Category: Quality/Clinical Effectiveness
Organization: AdventHealth PHSO Resources
Schedule: Full-time
Shift: 1 - Day
Req ID:
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
