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Clinical Documentation Improvement Manager

ChenMed

This is a Full-time position in Houston, TX posted July 16, 2021.

We’re unique.

You should be, too.

We’re changing lives every day.

For both our patients and our team members.

Are you innovative and entrepreneurial minded?

Is your work ethic and ambition off the charts?

Do you inspire others with your kindness and joy?

We’re different than most primary care providers.

We’re rapidly expanding and we need great people to join our team.

The High Risk Disease Detection (HRDD) Manager will be responsible for supporting the company Risk Adjustment program and ensuring that risk exposures and opportunities are identified with the key objective of optimizing revenue integrity and accuracy.

The HRDD Manager works to improve patient health and reduce hospital sick days by ensuring quality and accuracy of diagnoses and coding.ESSENTIAL JOB DUTIES/RESPONSIBILITIES: * Educates clinicians and non-clinician office staff on coding guidelines, documentation standards, and appropriate Medicare Risk Adjustment (MRA) procedures.* Assists in education and transition with onboarding new providers, optimally within their first month.* Reviews diagnoses and patient charts to identify trends and point out potentially missed chronic conditions to providers.* Develops educational material as needed to target identified gaps.

Reviews internal educational materials to ensure they are up to date; collaborates with Learning and Development when changes are necessary.* Sets up and conducts 1:1 meeting with market providers to communicate HRDD messages.* Assists during health plan and Compliance COE audits as needed.

Conducts quarterly audits of providers with high eMRA and meets with them frequently to achieve improvement.* Works with internal EMR to recommend accuracy in documentation and diagnoses.* Be the market level provider interface and liaison between corporate and HRDD.* Works closely with clinical and HRDD (High Risk Disease Detection) leadership to make sure coding standards are met and there is maximization of appropriate and accurate coding, as well as prevention of inappropriate coding.* Works with data teams to identify any potential gaps related to Risk Adjustment.* Collaborates with technology team to improve electronic documentation of all clinical conditions during encounters.* Stays abreast of CMS updated requirements and notifies IT so that dashboard can reflect the changes.* Collaborates with internal auditing team for appropriate capture and billing of HCC codes to simulate Risk Adjustment Data Validation audits.* Teams with health plan MRA departments as needed to ensure appropriate acceptance of encounter data and accuracy of submissions.* Collaborates with Operations Directors, Market Chief Medical Officers and Network Directors to identify areas of opportunities in HRDD.* Other duties as assigned and modified at manager’s discretion.

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better.

Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve.

We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire.

With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow.

Join our team who make a difference in people’s lives every single day.

KNOWLEDGE, SKILLS AND ABILITIES: * In depth understanding of Medicare Risk Adjustment, compliance and requirements, and coding guidelines* Understanding of clinical disease definitions and guidelines for identification* Ability to build trust, work with and effectively educate clinical providers (Physicians, Specialists, ARNPs, PAs)* Experience developing, implementing, maintaining and revising policies/procedures* Ability to educate and influence clinical leaders* Ability to work with multiple departments and critically evaluate for process improvements related to coding and billing for improved Risk Adjustment* Strong communication skills and ability to converse and collaborate with clinicians and other company leadership* This position requires up to 50% of travel nationwide EDUCATION AND EXPERIENCE CRITERIA: * Associate Degree preferred* Minimum five (5) years in coding, Medicare Advantage and experience in communication with providers in the medical field may substitute for degree* Certified Professional Coder and/or Certified Medical Record Auditor (AAPC or AHIMA)* Experience in data analytics and proficient in MS Office products, including Word, Excel, and PowerPointThe High Risk Disease Detection (HRDD) Manager will be responsible for supporting the company Risk Adjustment program and ensuring that risk exposures and opportunities are identified with the key objective of optimizing revenue integrity and accuracy.

The HRDD Manager works to improve patient health and reduce hospital sick days by ensuring quality and accuracy of diagnoses and coding.

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