Director, Clinical Excellence/BOI

Millennium Physician Group•US-Indiana-Remote, IN

5d•$137,150 - $205,724•Onsite

About The Position

The Director of BOI reports to the Director of Quality Programs. S/he is responsible for overseeing, coordinating, or performing data reviews and data-driven analysis to forecast/evaluate the performance of the risk adjustment program and refine annual risk adjustment program strategies to achieve optimal performance. S/he should foster and maintain vendor and carrier relationships to help drive optimum program success and meet contractual obligations. Identify areas of opportunity via reporting and workflow improvement throughout the organization. Collaborate between all areas of the organization to ensure success of our value-based coding initiatives such as provider engagement, education, prevalence rates, coding opportunities, documentation compliance and medical margin. The Director is tasked with improving the Risk Adjustment department through innovative technologies, leading, and growing the team and exploring future programs to enhance our position in Value Based Programs.

Requirements

Enrolled/or completed in Bachelor's degree from four-year college or university; And one to two years related experience and/or training; or equivalent combination of education and experience.
Position requires flexibility in work hours, multi-tasking, and excellent computer skills.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Proficient knowledge of Microsoft Excel Spreadsheet software; Microsoft Word Processing software, Outlook and ADP Payroll systems.
Knowledge of Computers, Fax, Portals, Uploading, Downloading, Athena or other Electronic Medical Record System.
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear.
The employee is frequently required to stand and walk.
The employee is occasionally required to stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 25 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Nice To Haves

CRC and /or CPC preferred.

Responsibilities

Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
Develop, Train and lead staff to review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether the diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
Ensure the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
Ensure any diagnosis code identified as being unsubstantiated by the record must be submitted to the carrier within timely guidelines to ensure on supported codes remain on record with those carriers.
Review for clinical indicators and query providers to capture the severity of illness of the patient.
Measure Providers’ performance on important aspects of care and service through data reviews and data-driven analysis.
Communicate and coordinate reviews with RA Provider Educator and Support Services for use in provider training sessions.
Facilitate and coordinate reporting to leadership within the organization as requested.
Manage the BOI Team in a positive manner with emphasis on providing excellent service to all patients, providers, internal and external customers.
Communicate to supervisor and IT Department regarding defects identified in the reporting systems or data base, suggest performance improvement opportunities and track through completion to ensure revenue capture.
Confirm code capture and proper RAF calculations by carriers.
Provide reporting for revalidation of codes, accept, and reject rates, code trends for areas of opportunity. Reporting by carriers, provider, POD, etc.
Assist with identifying and developing technology to enhance risk adjustment operations and accuracy Health plan ASM/EDS data submission or reconciliation.
Provide clear, concise and professional communication to varying audiences depending on the project and its goals.
Demonstrate excellent time management, attend and contribute to required meetings which may include travel as well as hours outside of standard business hours and/or above 40 hours per week.
Demonstrate the ability to train new leaders or provide ongoing education and training to existing staff/leaders along with regularly performing quality reviews and including feedback on opportunities for improvement to the Risk Coding team.
Directly supervise assigned employees in the Risk department. Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.