Quality And Population Health Manager

 Essential Functions

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provides direction and leadership to the quality team on a daily basis, including responding to questions regarding coding, workflows, systems and policy.
• Directly supervise the quality staff in the evaluation, prioritization, compilation and reporting of accurate medical records and coding information
• Exhibits a high level of understanding of HCC and chronic disease coding and documentation standards
• Knowledge of quality initiatives, HEDIS/STAR metrics and clinical quality performance
• Participation in New Employee Orientation for Providers and Clinical Support Staff
• Understanding of MIPS and knowledge related to enrolling, monitoring, and submitting
• Remains current on the specific data requirements as dictated by various government and private insurance carriers
• Drive initiatives with the team that contribute to performance by monitoring and prioritizing workflow and schedules
• Communicates effectively with physicians and administrators regarding quality, billing, coding and any other concerns the department may have
• Hiring, training and reviewing performance of staff as well as managing any corrective actions
• Conduct quarterly audits of all direct reports to ensure appropriate billing rules and guidelines are followed for timely payments
• Schedule and attend monthly and quarterly value-based meetings with health plans
• Reconciles quarterly value-based contract incentives
• Weekly and Monthly reporting to Director of Quality and Population Health
• Cultivates and maintains a positive and productive business relationship with clinical and administrative leadership, site supervisors, practice managers and operations team
• Conducts monthly one-on-one meetings with direct reports to provide structured feedback and discuss accomplishments and goals
• Ensures strict confidentiality of patient records
• Develops productive working relationships with co-workers by exhibiting honesty, respect and flexibility in order to meet department and organization objectives
• Develops and participates in in-service training activities and staff meetings and is available to participate in additional educational/ training sessions to expand skills
• Uses coding knowledge to assist peers in daily tasks and activities
• Travel may be required depending on business needs
• Hours may vary and be outside of normal office hours depending on business needs 

1. 1. High School diploma or GED required
   2. AA degree preferred.
   3. CPC and/or CRC Certification Required.
   4. Management experience preferred
   5. 5-7 years minimum experience required, specifically medical office/physician coding and medical chart review/auditing of documentation