- Educates clinicians and non-clinician office staff on coding guidelines, documentation standards, and appropriate Medicare Risk Adjustment (MRA) procedures.
- Assists in education and transition with onboarding new providers, optimally within their first month.
- Reviews diagnoses and patient charts to identify trends and point out potentially missed chronic conditions to providers.
- 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.
- Sets up and conducts 1:1 meeting with market providers to communicate HRDD messages.
- Assists during health plan and Compliance COE audits as needed. Conducts quarterly audits of providers with high eMRA and meets with them frequently to achieve improvement.
- Works with internal EMR to recommend accuracy in documentation and diagnoses.
- Be the market level provider interface and liaison between corporate and HRDD.
- Works closely with clinical and HRDD (High Risk Disease Detection) leadership to make sure coding standards are met and there is maximization of appropriate and accurate coding, as well as prevention of inappropriate coding.
- Works with data teams to identify any potential gaps related to Risk Adjustment.
- Collaborates with technology team to improve electronic documentation of all clinical conditions during encounters.
- Stays abreast of CMS updated requirements and notifies IT so that dashboard can reflect the changes.
- Collaborates with internal auditing team for appropriate capture and billing of HCC codes to simulate Risk Adjustment Data Validation audits.
- Teams with health plan MRA departments as needed to ensure appropriate acceptance of encounter data and accuracy of submissions.
- Collaborates with Operations Directors, Market Chief Medical Officers and Network Directors to identify areas of opportunities in HRDD.
- Other duties as assigned and modified at manager's discretion.
- Experience with Corporate Risk Adjustment interventions, playbook development, tactical roadmap development, and project timeline development.
- Excellent communication and interpersonal skills, with the ability to effectively communicate with individuals at all levels of the organization.
- Strong project management skills with experience in implementing and fine-tuning core programs.
- Strong analytical skills and ability to understand and interpret data to drive performance improvements.
- Knowledge of CMS-HCC Risk Adjustment Models , Risk Adjustment Coding and documentation Improvement .
- Understand and Interpret Risk Adjustment Payor Reporting requirements preferred.
- Strong leadership skills and ability to work collaboratively in a matrix environment.
- Ability to travel as needed to support markets.
- Bachelor's Degree in Healthcare Management, Business Administration, or related field; Master's degree preferred.
- Minimum of 5-7 years of experience in Healthcare Management, with experience in market engagement and provider performance.
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Manager, High Risk Disease Detection - Miami, United States - ChenMed
Description
We're unique. You should be, too.
We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.
The High Risk Disease Detection (HRDD) Manager will be 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 HRDD Manager works to improve patient health and reduce hospital sick days by ensuring quality and accuracy of diagnoses and coding.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
KNOWLEDGE, SKILLS AND ABILITIES:
EDUCATION AND EXPERIENCE CRITERIA:
We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.
Current Employee apply HERE
Current Contingent Worker please see job aid HERE to apply
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