Senior Director, Risk Adjustment

ChenMed

4d•Onsite

About The Position

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 Senior Director, Risk Adjustment directs and oversees the centralized clinical operation services of Coding , Auditing, Data Analysis, & Quality Assurance of the Risk Adjustment COE that serves all markets in the ChenMed family of companies. The incumbent in this role supports the Core Clinical Model by managing the strategy, central operations and support of high-risk disease detection initiatives, which is critical for improved high-risk disease management.

Requirements

High business acumen and acuity
Skillful clinical knowledge of disease processes and management; ICD 10 Coding
Extensive knowledge of value-based care model, including drivers of VIP Service, High Risk Disease Detection and Management, and Reducing Hospital Sick Days
Ability to lead teams of professionals in a challenging, everchanging and fast-paced environment
Excellent interpersonal skills including the ability to effectively influence both internal and external key stakeholders including, executives, physicians, and other clinicians, and the confidence to represent ChenMed’s mission, vision and values at all levels
Proven ability to design, implement and execute processes that support high volume work activity, as well as, ensuring due diligence and accuracy.
Ability to build, leverage and sustain internal and external business relationships
Keen organizational and analytical skills with precise attention to detail and accuracy
Excellent verbal and written communication skills
Advanced knowledge and skills in Electronic Medical Records (EMR) systems
Adept knowledge of medical laws and regulations
Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
Ability and willingness to travel locally, regionally and nationwide up to 35% of the time
Spoken and written fluency in English
Bachelor’s degree in Health Information Management, Healthcare Administration or a closely related field OR additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis required
A minimum of ten (10) years’ experience in healthcare and management required
A minimum of two (2) years’ experience in Coding and Medicare Risk Adjustment required
Managerial experience leading teams of professionals required

Nice To Haves

Certified Medical Coder through the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA) or a similar accredited program preferred
Specialized training and/or education and/or experience in clinical field (nursing/medicine) desired
Specialized training and/or education and/or experience in quality improvement desired

Responsibilities

Oversees the strategic operations of ChenMed’s Risk Adjustment Coding, Auditing, Education, Data Analysis, & Quality Assurance COEs.
Directly manages the Directors and/or Managers of each COE.
Plans and implements new and revised clinical programs and services across the enterprise.
Leads projects aimed at improving diagnostic and coding accuracy and collaborates with IT and Data teams to ensure accurate submission of Risk Adjustment codes to health plans.
Ensures each department under Risk Adjustment has updated policies and procedures that comply with state and federal regulations.
Works closely with clinical leadership to make sure coding standards are met and there is maximization of appropriate and accurate coding, as well as, prevention of inappropriate coding.
Trains Risk Adjustment Education, Auditing, & Coding teams to educate clinicians on documentation requirements to comply with CMS standards.
Collaborates with technology teams to improve electronic documentation of all clinical conditions during encounters.
Oversees the internal auditing process for appropriate capture and billing of HCC codes to simulate Risk Adjustment Data Validation audits.
Assists during health plan and Compliance COE audits for Risk Adjustment as needed.
Collaborates with health plan MRA departments to ensure appropriate acceptance of encounter data and accuracy of submissions.
Structures, strategizes, hires, trains, guides and manages Risk Adjustment Educators in their daily activities as assigned per market.
Analyzes market needs for Risk Adjustment Education, Coding, Auditing, Data Analysis, & Quality Assurance FTEs and structures central team to service market needs and comply with company’s policies.
Works as a facilitator in informing central corporate teams on particular market situations.
Assists in analyzing and presenting data back to stakeholders.
Interacts with IT, Analytics, Digital, Trans Care, Learning and Development, Operations and Clinical to coordinate Coding, Auditing, Education, and Quality Assurance activities with markets.
Attends monthly meetings with market leadership teams to coordinate needs and expectations from Risk Adjustment.
Works with MFOs and central finance team to project MRA for following year based on current trends and data.
Reconciles the data within the enterprise to ensure completeness and accuracy.
Analyzes data to enable decision-making and develops reports for management, executives, clinical leads, providers and others to support their achievement of work goals and processes.
Oversees coding & auditing team and leads their operations, by assigning and distributing essential functions ensuring productivity.
Oversees education and training to market staff on Risk Adjustment activities needed to maximize performance.
Ensures accuracy and completeness of work, efficient staffing levels and effective training of employees.
Provides leadership and conducts performance reviews of direct reports.
Builds and develops existing team to provide front line support to internal customers.
Ensures successful onboarding process by collaborating with Physician Recruiters and HR teams.
Creates, maintains and updates content for initial and ongoing training of clinicians.
Performs other duties as assigned and modified at manager’s discretion.