Risk Management Director - Healthcare jobs in Atlantic City, NJ

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Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.

Overview

Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient. Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief. Provides education to providers on the importance of diagnosis specificity. May participate in developing, presenting, and disseminating provider communication and other activities related to clinical documentation.

Responsibilities

Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage, MSSP and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum

Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)

Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines

Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation

Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing

Provides ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education and support for improvement in HCC coding and RAF scoring. Assists with educational in-services for physicians, other providers, and clinic staff relating to clinical documentation compliance related to billing.

Credentials

Education

Other Information

Required Certification/Licensure: Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC

Minimum of two years' experience in medical coding

Reliable transportation/Valid Driver's License/Must be able to travel at least 50% of work time

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