Manager-Clinical Documentation Senior

Overview

Clinical Documentation Manager

Summary:

The Clinical Documentation Manager assists in the development of operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment. This position supports and aligns planning to ensure the key strategic activities aimed at HCC/RAF management for Value-Based Care is delivered and executed at the clinic level. Expert in reviewing, assigning and validating ICD-10-CM codes for diagnoses performed by physicians and other qualified healthcare providers. Ensures diagnostic coding accuracy and compliance for each Plan’s member. The Clinical Documentation Manager will coordinate work in clinics to provide support and education to all market leaders, Providers and clinic staff. This position identifies, develops and implements simplification and automation to improve HCC/RAF initiatives. The Clinical Documentation Manager will also act as a facilitator, leader, mentor and change agent. Travel is required throughout the region.

Duties:

• Review clinical documentation and assign accurate diagnosis codes according to guidelines and project
• Review medical documents such as surgical reports, medical visits, and diagnostic reports in order to create educational strategies to ensure correct diagnosis code assignment by the provider.
• Perform Clinical Chart Audits for proper HCC documentation on an ongoing basis.
• Extracts data from practice EMR or network database to identify HCC documentation and care gap opportunities to assess positive and negative changes in quality scores month over month.
• Reviews registries with PCPs and/or key office staff to identify care gaps and opportunities for outreach, HCC documentation and/or care gap closure.
• Be able to identify opportunities in diagnosis coding, clinical documentation and billing within the provider’s day-to-day operations.
• Collaborate with and support primary care providers and practice support staff to improve population health performance and achieve quality incentives related to managed care contracts by managing and organizing data, engaging patients, and optimizing workflow, with the goal of optimizing our patients’ health and wellbeing.
• Facilitates and assists with outreach to patients via phone calls, mail or electronic messaging, to schedule appointments, screenings, and preventive tests.
• Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process.
• Maintains a log of audits and education performed of diagnosis/HCC gaps.
• Prepares and submits a monthly report of activities performed during payer meetings.
  
  

Core Competencies:

• Understands the CMS-HCC (Hierarchical Condition Category) Risk Adjustment Model and ICD-9/10 guidelines.
• Extensive background in supporting risk adjustment management activities and clinical informatics
• Experience with Risk Adjustment Data Validation
• Demonstrate the ability to teach and evaluate clinical staff as it relates to HCC/RAF management at the clinic level.
• Maintain compliance with AAPC coding standards and CMS Risk Adjustment guidelines.
• Remains current on CMS rules and guidelines.
  
  

Preferred Required

Minimum Required Preferred / Desired Experience

5 years of general healthcare experience

3 years of clinical coding experience with strong attention to detail and a high level of accuracy.

Education Registered Nurse and/or AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) Bachelor's Degree in Nursing (8 or more years of additional experience beyond the required years of experience may be substituted in lieu of a bachelor's degree. Training Certified Risk Adjustment Coder (CRC) certification or proof that certification has been obtained within 6 months of start date from the American Academy of Professional Coders. Special Skills MS Office Suite, moderate to advanced EXCEL and PowerPoint skills. Knowledge of audiovisual equipment set up. Licensure AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) or if current RN license in good standing, must be a Certified Risk Adjustment Coder (CRC)

Ability to work a flexible work schedule and travel to all assigned BMG clinics.