Sr. Director, Accurate Clinical Documentation

About the Role

Senior Director of Accurate Clinical Documentation is a key leadership position responsible for driving strategic initiatives, vendor management, and operational efficiency within the Wellvana Clinical Documentation organization. This position requires a seasoned professional with a strong background in Clinical Documentation Improvement. This includes experience managing vendors, coding teams, implementing new services, and coding quality assurance.

Key Responsibilities

• Lead service delivery and oversight of the risk adjustment coding/auditing team and clinical documentation provider education team, managing 2 direct reports (Sr. Manager level) and a total org of 23 team members
• Own oversight of two key vendor relationships performing Clinical Documentation services
• Oversee and optimize clinical documentation programs while ensuring high-quality education and training for Wellvana's partners and members of our ACOs
• Provide strategic planning, risk assessment, operational leadership, and compliance management

Clinical Documentation Strategy

• Lead teams and vendors to execute a comprehensive clinical documentation/risk adjustment strategy in alignment with Wellvana's goals and objectives
• Provide input into continued refinement of comprehensive strategy and overall partner services support, tools, technology, and analytics
• Raise people, process, and technology concerns and opportunities to senior leadership and provide input into solutions
• Oversee clinical documentation processes to accurately capture patient acuity and severity for appropriate benchmarks and reimbursement across Wellvana's line of businesses (currently MSSP and MA)

Educational Program Management

• Execute strategy of segmenting and stratifying partners and practices for provider education services: full service, hybrid, and consultative
• Assist in refining strategy where needed
• Oversee creation of relevant curriculum and training materials for clinical documentation provider education

Compliance and Regulatory Oversight

• Ensure compliance with all relevant healthcare regulations, including CMS guidelines for risk adjustment
• Stay updated on changes in regulations and adjust strategies and programs accordingly

Team Leadership

• Recruit, mentor, and lead a team of professionals responsible for risk adjustment coding/auditing team and clinical documentation provider education
• Foster a culture of continuous learning and improvement within the team

Data Analysis and Reporting

• Measure results of programs and monitor success against Wellvana and partner level targeted goals for improvement of benchmark accuracy and other key performance indicators
• Provide regular reports to senior leadership and stakeholders

Collaboration and Stakeholder Engagement

• Collaborate with healthcare providers, payers, and internal departments to ensure accurate risk capture and reporting
• Engage with key stakeholders to align risk adjustment, quality, and clinical education initiatives and services
• Strategize with the Partner Success team on engagement tactics and relationship-building processes for ACD team to engage with practices

Quality Assurance

• Implement quality assurance processes to monitor the effectiveness of programs, both internal and vendor
• Monitor vendor adherence to SLAs and mitigate issues

Continuous Improvement

• Identify areas for improvement in risk adjustment and quality education programs, clinical documentation services, vendors, and technology and implement changes to drive better outcomes
• Encourage innovation and the adoption of best practices

Qualifications

• Education: Master's degree or higher in healthcare administration, healthcare management, or a related field preferred
• Certifications: CRC & CPC preferred
• Experience: 10+ years of experience in Risk Adjustment operations and leadership with Medical Coding, Auditing and Education operations or vendor management preferred
• Significant experience in risk adjustment or revenue cycle management
• Experience managing risk adjustment vendors
• Experience in Quality preferred
• Strong knowledge of healthcare regulations, especially related to risk adjustment
• Excellent leadership and team management skills
• Proficiency in data analysis and reporting
• Effective communication and interpersonal abilities
• Commitment to continuous learning and staying updated on industry trends
• Experience with educational program development and delivery is a plus

Core Values

• Integrity: The right way is the only way
• Dependability: You do what you say you're going to do
• Advocacy: You fight for the best possible outcome for providers and their patients
• Clarity: You make it all understandable