Manager-Clinical Documentation Senior

Duties

• Review clinical documentation and assign accurate diagnosis codes according to guidelines and project
• 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
• Reviews registries with PCPs and/or key office staff to identify care gaps and opportunities for outreach, HCC documentation and/or care gap closure
• 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
• Maintain a log of audits and education performed of diagnosis/HCC gaps
• Prepare and submit 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
• 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

Required

• 5 years of general healthcare experience
• 3 years of clinical coding experience with strong attention to detail and a high level of accuracy
• Registered Nurse and/or AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC)
• Bachelor's Degree in Nursing (with 8 or more years of additional experience beyond the required years of experience may be substituted in lieu of a bachelor's degree)
• 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

Preferred / Desired

• MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
• Knowledge of audiovisual equipment set up
• Able to work a flexible work schedule and travel to all assigned BMG clinics