Senior Manager Clinical Documentation Integrity

THE EXPERTISE AND EXPERIENCES YOU’LL NEED TO SUCCEED:

• Expert level knowledge of all risk adjustment methodologies.
• Expert level knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, compliance audit concepts
• Knowledge of regulations related to data submission for Medicare Advantage, MMP, and Marketplace risk adjustment.
• Knowledge of CMS response files including RAPS, RAPS returns, MAO-002, MAO-004, as well as RAPS and EDPS submission formats and file protocols

EDUCATION AND EXPERIENCE REQUIRED :

• Minimum seven years of experience in RAF coding
• 3 years’ experience as a manager/supervisor
• Bachelor’s degree in business, health care, or related field. Minimum seven years of experience in RA EXPERIENCE PREFERRED:
• Master’s degree in business, health care, or related field.

The Population Health Services Organization (PHSO) Senior Manager of Clinical Documentation Integrity (CDI) will be responsible to manage, build provider incentive programs, and develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Ri Clinical Documentation Integrity Program. This will include but not be limited to developing the overall structure and operations to support programs in Risk Adjustment coding, CDI review, working on Electronic Medical Record tools, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and economic outcomes. Ensure that risk adjustment related programs are performing and compliant and in all regulatory mandated and contractual activities. Monitor key program and population metrics, as well as participate in process improvement efforts serving as a risk adjustment coding resource for network physicians, PHSO committees, members, medical services, health management, and member service staffs as well as other internal and external partners. Responsible for actively identifying opportunities of improvement and developing and driving annual clinical initiatives related to the risk adjustment coding management for the populations served. Risk Adjustment Factor (RAF) topic educator and training resource to population health services and programs to PHSO and Integrated delivery system partners. Additionally, responsible for reviewing and identifying any opportunities in coding policies and procedures and providing clinical and economic data necessary to make recommendations.