CHESS Health Solutions · 3 hours ago

Condition Management & Documentation Manager

Winston-Salem, NC

Full-time

Remote

Mid, Senior Level

5+ years exp

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Responsibilities

Develops, coordinates, and implements the strategic direction of the CMD program as it relates to the education for CHESS Health Solutions. This includes providing education, consultation and direction to the providers and all levels of the organization as it relates to managing clinical risk.

Develops, standardizes, maintains, and implements risk adjustment training programs, materials, websites, and workflows for all areas of the organization to achieve CMD program goals.

Serves as the subject matter expert and internal primary point of contact for all Condition Management and Documentation related topics and guidance by maintaining an expert level of knowledge of Medicare and risk-based reimbursement methodology including CMS & IMO updates affecting HCCs, ICD 10 coding practices, Medicare/HHS risk adjustment models, Hierarchical Condition Categories (HCCs) and Risk Adjustment Factors (RAFs), clinical/charge capture functionality, internal processes and maintains professional and technical knowledge through webinars, workshops, professional publications and personal networking.

Works with coding/coding auditors to develop work queues/rules to identify CMD related focus areas for querying for missed codes and coordinate manual chart reviews of a practice to analyze clinical documentation to identify patterns and trends to develop appropriate Performance Improvement plans.

Participates with coding and compliance in risk-adjustment chart reviews including RAD-V/RACCR audits to identify patterns and trends and shares findings as appropriate.

Develops and maintains effective internal relationships through effective and timely communication.

Data mines & synthesizes raw data and organizes key performance indicators, presents information, and provides summary of material. Provides analysis and reporting on progress and results including the overall RAF score, improvement strategies and tactics.

Collaborates with quality, operations, and providers to develop recommendations to complete PDSA/Improvement plans to drive Risk Adjustment improvement that includes creating tools and reports to meet CMD goals.

Collaborates with other all necessary within CHESS and Enterprise Population Health.

Other duties as assigned.

Qualification

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Health Information ManagementRisk Adjustment CodingICD coding guidelinesMedicare Advantage knowledgeEPICData analysisMicrosoft WordMicrosoft PowerPointMicrosoft ExcelMicrosoft OutlookService orientationEthical practice

Required

Bachelor's Degree in Health Information Management, or Bachelor’s Degree in Nursing or related field

Minimum 5 years of experience commensurate with position’s responsibilities

Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or Registered Nurse license issued by the state in which the team member practices, or Certified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC) needs to be obtained within 1 (one) year.

Preferred

Typically requires 5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)

Medicare Advantage knowledge (strong preference)