CHESS: Manager, Condition Management & Documentation

Manager, Condition Management & Documentation

Position Summary:

Coordinates, facilitates, implements, and participates as a subject matter expert within the organization for Condition Management and Documentation (CMD). The role is responsible for Condition Management and Documentation education, performance improvement planning and monitoring the comprehensive Condition Management and Documentation plan for CHESS Health Solutions. The role partners closely with Enterprise Population Health Coding and Auditing teams. This role implements new and existing healthcare Risk Adjustment strategies, provides education and workflow recommendations to providers, identifies EHR CMD related opportunities, troubleshoots and tests CMD related EHR enhancements and conducts data collection; and is responsible for monitoring key performance measurement activities.

Position 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.
  
  
  

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

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)
  
  
  

Skills

Skills, Knowledge, and Abilities

• Ability to lead programs interacting with all levels of the organization
• Strong knowledge of ICD diagnoses coding guidelines and Medicare Risk Adjustment Payment Methodology related to HCC/RAFs
• Knowledge of payor plan requirements and impact to RAF scores as it relates to MSSP and Medicare Advantage programs
• Knowledge of EPIC and reporting solutions
• Ability to operate in a fast-paced, dynamic environment
• Detail oriented; possess strong initiative, problem solving skills and ability to set/manage multiple priorities to meet deadlines in an expedient and decisive manner with minimal supervision
• Intermediate proficiency in Word, PowerPoint, Excel, Outlook including ability to create pivot tables, formatting, sorting, create sheets with formulas (sum, vlookup)
• Strong verbal/written communication skills; ability to present in front of a group; ability to translate coding/EHR issues in plain language to providers via tip sheets, case studies, in person/emails
• Excellent organizational capabilities to execute projects/program and work effectively as a team player
• Strong aptitude for critical thinking and demonstrated analytical and data skills. Willingness to acquire new knowledge from an unfamiliar domain
• Able to drive to various sites throughout the CHESS Health Solutions footprint, if needed
• Ability to work from home or in an office setting.
• Operates all equipment necessary to perform the job.
  
  
  

Key Competencies

• Service orientation
• Integrity
• Ethical practice and confidentiality
  
  
  

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