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Manager, Risk Adjustment Clinical Quality Documentation - Oakland, United States - Brown & Toland
Description
Job Description
Job Title:
Manager , Risk Adjustment, Clinical Quality Documentation
FLSA Status:
Job Code :
Pay Grade:
Core Bay Area 13
Date/Revision Date:
2/3/2022
Track:
Family:
Clinical Performance
Level:
Sub-Family:
CQDP
Job Summary & Responsibilities
Job Summary
The Risk Adjustment Manager provides leadership and direct support for Brown & Tolands key risk programs across all lines of business. This position will work directly with leaders to deploy a comprehensive coding, documentation, chart chase, and annual health assessment programs to ensure compliant and sustainable growth. This also includes managing and developing direct reports, program Implementation, work plan development, vendor management, and data- driven performance improvement.
Essential Functions
Stay informed of all risk related program requirements from CMS and develop implementation strategies to CMS requirements.
Oversee implementation of risk adjustment analytics platform and related technological solutions, including integrated POC tools within EPIC
Develop best practices related to data aggregation as it relates to coding, claims, encounter data, and lab data
Lead cross-functional workgroups to design and monitor risk adjustment programs including retrospective and prospective chart chases, provider education programs, Annual Health Assessment programs, and coding.
Manage relationships with 3rd party vendors and health plans and other organizations who are providing services, products, and solutions to support risk and quality related programs.
Meet with direct reports on a weekly basis for 1-1 meetings
Review contracts collaborate with Legal and Compliance
Review Budgets and approve Invoices as per VP of Clinical Performance
Key Skills
Ability to work independently and problem solve
Ability to clearly communicate, both verbally and in written format
Proficient in Microsoft Excel and Word
Meeting facilitation
Epic EMR experience preferred
Proficient in Power Point
Excellent organizational skills
Management
This position supervises staff : Specialists, RNs, Coders, NPs
Qualifications
Education
Bachelors degree or equivalent experience required, MBA or other advanced healthcare degree preferred
CRC, CPC, or other relevant certification through AAPC preferred
Experience
Five plus (5+) years healthcare administration experience preferred; other relevant experience will be considered; previous risk adjustment and/or Medicare STARS experience a strong plus.
Role Competencies
Competency
Level
Description
Core Competencies
Collaboration
Individual Contributor
Works cooperatively with Team members across the organization to achieve shared objectives
Partners with Team Members to get work done
Gains trust and support across the organization
Excellence
Individual Contributor
Regularly meets targets and metrics
Pushes Team Members to set high standards and performance targets and exceed them
Sets solid targets that drive results
Compassion
Individual Contributor
Contributes to a work climate where differences are valued and supported
Applies Team Members diverse experiences, styles, backgrounds and perspectives
Treats Team Members with kindness
Integrity
Individual Contributor
Acts fairly despite conflicting demands
Behaves in a way that is consistent with what he/she says around honesty, ethics, and integrity; leads by example
Presents truthful information even if not always favorable
Innovation
Individual Contributor
Introduces new ways of looking at problems
Can take a creative idea and put it into practice
Encourages diverse thinking to promote and nurture innovation
Work Dimensions
Level Factor
Requirement (direct from leveling guide)
Work Dimension
Scope & Impact
--
Knowledge & Skill
Developing professional expertise
Complexity
Works on problems of moderate scope, Exercises judgment within defined procedures
Interaction
--
Supervision
Normally receives general instructions on routine work
Experience
Typically requires Bachelors degre e , 5 + years professional experience
Activity: Sit: Continuously (more than 2/3 of the work shift)
Activity: Stand: Occasionally (up to 1/3 of the work shift)
Activity: Walk: Occasionally (up to 1/3 of the work shift)
Motion: Bend/Twist: Up to 1/3 of time
Motion: Carry/Lift: Up to 1/3 of time
Motion: Reach: Up to 1/3 of time
Motion: Squat: Up to 1/3 of time
Use of Hands (Left/Right): General Motor Function
Use of Hands (Left/Right): Precise Motor Function (Or Fine Manipulation)
Use of Hands: Repetitive Motion: 1/3 or more of time
Weight Lifted/Force Exerted: Up to 10 lbs: Up to 1/3 of time
Work Environment: Special visual or auditory requirements including working with a computer terminal.
