Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)
About The Position
Responsible for leading the quality documentation and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD-10 codes). This role serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation. The manager will develop and deliver clinical focused training on advance coding and documentation while incorporating coder feedback. They will act as a liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation. Additionally, the role involves developing a performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment. The manager will also develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures. They will develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success. Participation in peer review of medical documentation for completed visits notes as well as patient profile information in EMR is also a key responsibility. The manager will hire, train, coach, counsel, and evaluate the performance of direct reports.
Requirements
- Requires a current, active, valid, and unrestricted nurse practitioner (NP) or physician assistant (PA) license from the state in which you reside.
- Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
- Requires experience with CMS Risk Models.
Nice To Haves
- Previous management/supervisory experience with direct reports.
- HEDIS experience is preferred.
- Experience with clinical data/documentation integrity is preferred (CDEO or CDEI).
- Prefer AAPC Certified Risk Adjustment Coder (CRC) certification.
Responsibilities
- Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation.
- Develop and deliver clinical focused training on advance coding and documentation while incorporating coder feedback.
- Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation.
- Develop performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment.
- Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures.
- Develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success.
- Participate in peer review of medical documentation for completed visits notes as well as patient profile information in EMR.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Manager
