Clinical Operations Quality Manager
Reveleer
Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.
As a Clinical Operations Quality Manager, you will be a vital member of the team responsible for ensuring all clinical resources are trained and enabled to perform their job duties with good productivity and quality.
ESSENTIAL FUNCTIONS:
- Clinical Quality Program Design:
Design, develop and deploy A quality program that sets quality expectations, monitors results and assists the operation managers with executing.
- Quality Development: Validate that all coders on DQA are improving and have on-going QA and development. Make sure all coders have a level of QA.
- On-boarding: Provide on boarding overread
- Review Data: review daily reports for QA scores and issues and work with training on education for employees who need it.
- Provide continued feedback to leaders regarding quality trends, and additional training needs.
- Provide in depth analysis of quality issues and create an action plan to set up company for success.
- Ensure collaboration among cross functional teams for the roll out of product releases.
- Additional duties as necessary to meet the obligations to our customers.
CORE COMPETENCIES
- Caring – Warm, sincere, calm, cool and collected energy and presence with the ability to develop relationships.
- Analytical Skills and Attention to Detail– Reviewing clinical documentation and coding .
- Effectively Communicates – Speaks clearly, listens effectively, and responds well to questions; Writes clearly and informatively; Edits work for errors; Varies writing style to meet needs; Able to read and interpret information; Documents are accurate and delivered on time; Uses good judgement when communicating information
- Interpersonal Skills - Builds strong relationships; Flexible and open minded; Receptive to feedback; Motivates employees and peers for the purpose of achieving organizational goals.
- Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Adaptability – Adapts to changes in the work environment; Adjusts methods to best fit the situation; Able to deal with change, delays, or unexpected events. Can work with diverse groups of customers and internal stakeholders.
- Cultural Sensitivity – Models behaviors that reflect the culture of Reveleer; Awareness of the similarities and differences that exist between employees, teams, departments and customers to build more effective relationships
- Computer Skills – Essential to be skilled in with all Microsoft Suite products (e.g. Excel, Word, Powerpoint, etc.)
SUCCESS CRITERIA
- All staff have a combined quality score of over 96%
- Customers are satisfied with our clinical quality
QUALITFICATIONS – EDUCATION- CERTIFICATIONS – SPECIALIZED SKILLS
- Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA
- Minimum of 2 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC)
- Bachelor’s degree preferred
- Travel as needed
SALARY RANGE: $80,000 - $95,000 / annually
Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.
Reveleer E-Verifies all new hires.
Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.
