Manager, Clinical Data Integrity

SUMMARY:
Our Healthcare organization is seeking a highly experienced Manager of Clinical Data Integrity. This position will oversee day to day operations related to Risk Adjustment and Encounter Data submission across multiple health plan and provider organization clients.
EDUCATION:
• BACHELOR’S DEGREE IN RELATED FIELD OR FIVE (5) YEARS RELATED EXPERIENCE
LICENSES/CERTIFICATIONS:
A certification in one of the following is required:
• Certified Professional Coder (CPC)
• Certified Risk Adjustment Coder (CRC)
• Certified Coding Specialist (CCS)
• Registered Health Information Administrator (RHIA)
• Certified Professional Medical Auditor (CPMA) strongly preferred
EXPERIENCE:
• Minimum five (5) years of experience auditing medical record coding
• Minimum three (3) years of experience leading individual contributors and/or team leaders
• Minimum three (3) years of experience managing retrospective and prospective Risk Adjustment initiatives
• Experience related to health plan Encounter Data submission and rejection management strongly preferred
SKILLS:
• Subject matter expertise in Risk Adjustment coding and CMS data validation
• Demonstrated ability to execute complex projects and operational processes in a matrixed environment
• Strong analytical, organizational, and interpersonal communication skills
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Excellent leadership and communication skills
• Ability to interpret and utilize Clinical Data analytics to formulate data driven healthcare strategies
• Strong analytical and problem-solving skills, with the ability to analyze complex data and identify trends and opportunities for improvement
RESPONSIBILITIES:
• Under minimal supervision create, analyze, monitor and manage strategic operations related to Medicare and Affordable Care Act / Exchange Risk Adjustment programs
• Serve as primary lead for managing successful submission of encounter data and coordinate with internal partners to resolve encounter rejections and data discrepancies
• Oversee and monitor vendor relationships directly impacting Risk Adjustment and Encounter operations, ensuring timely execution of expected deliverables to clients based on need and regulatory requirement
• Design and execute risk mitigation coding oversight activities based on guidance provided by CMS (Centers for Medicare & Medicaid Services) & OIG (Office of Inspector General) to improve accuracy of risk adjustment data collected and submitted
• Effectively train and coach staff to ensure they are equipped with up-to-date business knowledge
• Ensures accurate development, analysis and reporting of key risk adjustment and encounter metrics, as well as overseeing analysis of new legislation and regulations
• Develops business requirements, functional requirements, process flows, reference materials, user guides as appropriate
TECHNICAL SKILLS:
• Advanced skills in Microsoft Office products: Excel, Outlook, Word, PowerPoint, etc.
• Working knowledge of Electronic Health Records (EHR)
• Proficient in the use of healthcare analytics software and tools
ABOUT APEX HEALTH SOLUTIONS
Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.