Manager-Clinical Documentation Senior

Baptist Memorial Health Care

Memphis (TN)

On-site

USD 75,000 - 90,000

Full time

14 days+

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Job summary

A healthcare organization in Memphis seeks a Manager-Clinical Documentation Senior to assist in developing best practices for Risk Adjustment. The role entails reviewing clinical documentation, validating diagnosis codes, and providing support to clinic staff. Candidates should have extensive experience in healthcare, a background in clinical coding, and relevant certifications. This position requires travel to clinics and offers a flexible schedule.

Qualifications

5 years of general healthcare experience.
3 years of clinical coding experience with a high level of accuracy.
Bachelor's Degree in Nursing or equivalent experience.

Responsibilities

Review clinical documentation and assign accurate diagnosis codes.
Prepare and submit monthly reports of activities.
Educate clinical staff on the Risk Adjustment process.

Skills

ICD-10-CM codes

Risk Adjustment Data Validation

Clinical informatics

Teaching ability

Attention to detail

MS Office Suite

Excel skills

PowerPoint skills

Education

Registered Nurse or AAPC Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

Job description

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Job Summary

The Clinical Documentation Manager assists in the development of an operational framework focused on scalable and repeatable best practices relating to Risk Adjustment. This position supports and aligns planning to ensure the key strategic activities aimed at HCC/RAF management for Value-Based Care are delivered and executed at the clinic level. The manager is an expert in reviewing, assigning, and validating ICD‑10‑CM codes for diagnoses performed by physicians and other qualified health care providers. Ensures diagnostic coding accuracy and compliance for each plan’s member. The Clinical Documentation Manager coordinates work in clinics to provide support and education to market leaders, providers, and clinic staff. The role identifies, develops, and implements simplification and automation to improve HCC/RAF initiatives. The manager acts as a facilitator, leader, mentor and change agent. Travel is required throughout the region.

Duties

Review clinical documentation and assign accurate diagnosis codes according to guidelines and project requirements.
Review medical documents such as surgical reports, medical visits, and diagnostic reports to create educational strategies to ensure correct diagnosis code assignment by providers.
Perform clinical chart audits for proper HCC documentation on an ongoing basis.
Extract data from practice EMR or network database to identify HCC documentation and care gap opportunities to assess positive and negative changes in quality scores month over month.
Review registries with PCPs and/or key office staff to identify care gaps and opportunities for outreach, HCC documentation and/or care gap closure.
Identify opportunities in diagnosis coding, clinical documentation and billing within the provider’s day‑to‑day operations.
Collaborate with and support primary care providers and practice support staff to improve population health performance and achieve quality incentives related to managed care contracts by managing and organizing data, engaging patients, and optimizing workflow.
Facilitate and assist with outreach to patients via phone calls, mail or electronic messaging to schedule appointments, screenings, and preventive tests.
Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process.
Maintain a log of audits and education performed of diagnosis/HCC gaps.
Prepare and submit a monthly report of activities performed during payer meetings.

Core Competencies

Understands the CMS‑HCC (Hierarchical Condition Category) Risk Adjustment Model and ICD‑9/10 guidelines.
Extensive background in supporting risk adjustment management activities and clinical informatics.
Experience with Risk Adjustment Data Validation.
Demonstrates the ability to teach and evaluate clinical staff as it relates to HCC/RAF management at the clinic level.
Maintains compliance with AAPC coding standards and CMS Risk Adjustment guidelines.
Remains current on CMS rules and guidelines.

Required Experience

5 years of general healthcare experience.
3 years of clinical coding experience with strong attention to detail and a high level of accuracy.

Education & Training

Registered Nurse and/or AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC). Bachelor's Degree in Nursing (8 or more years of additional experience beyond the required years may be substituted in lieu of a bachelor's degree).
Certified Risk Adjustment Coder (CRC) certification or proof that certification has been obtained within 6 months of start date from the American Academy of Professional Coders.

Special Skills

MS Office Suite, moderate to advanced Excel and PowerPoint skills.
Knowledge of audiovisual equipment set up.

Licensure

AAPC Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) or if current RN license in good standing, must be a Certified Risk Adjustment Coder (CRC).

Other Requirements