Director of MRA Coding and Clinical Documentation
1 month ago
*Valora Medical Group* is a visionary company focused on high-quality primary care services and consists of healthcare providers and professionals dedicated to the health and well-being of our patients. At Valora, we treat our patients like family and we understand that providing quality medical care and an exceptional patient experience across all our centers requires having an outstanding team.
The *Director of Medical Risk Adjustment (MRA) and Clinical Documentation* will assist in the development and implementation of a long-term strategy to achieve continuous improvements as it relates to Quality and Coding. This person will ensure that Valora’s Risk Adjustment programs comply with all applicable guidelines, regulations, and laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), and others established at the state and federal levels.
This person will direct and manage a team of coders while creating a culture focused on Compliance and Core Behaviors. This leader will build strong partnerships with Valora’s cross-functional teams including Care Management, Clinical Operations, Medical Providers, and leadership to develop programs that deliver measurable, actionable solutions resulting in improved accuracy of medical record documentation and coding.
Promotes the strategy and capabilities to develop risk management and physician/member initiatives that support provider documentation and coding accuracy. Executes audits performed by government agencies (e.g., CMS, HHS), internal Compliance and other validation audits to ensure efficacy of documentation, coding and quality for Valora members.
Develops and implements provider education strategies and tools, monitoring provider performance, developing corrective action plans, direct provider interventions, and assisting physicians, and offices that perform below quality benchmark.
*Essential Duties and Responsibilities:*
* Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
* Audits: Oversee the collection and validation of historical member clinical data to fulfill any audit requests. Includes retrieval of medical records, validation of member clinical conditions and confirmation of reimbursement values received from Managed care plans. Responsible for overseeing operational efforts and providing status / results to executive leadership.
* Provider Education: Assist in leading interventions to address quality concerns relating to Provider clinical information. Compose and distribute education materials to physician to aid the collection of complete and accurate member profile documentation.
* Production Coding: Manage a team of internal coder/clinicians that perform Risk Adjustment coding of medical records. Track production coding results and monitor accuracy of coding.
* Quality Assurance on Virtual Programs coding results: Lead team of coder/clinicians to review member medical records to validate 100% of new diagnoses submittable to MAPD plans for reimbursement.
* Compliance Oversight: Oversee staff devoted to ongoing updates/policy modifications distributed by CMS. Serves to alert relevant stakeholders and propose new operational policy/process updates to comply with regulatory mandates.
* Act professionally and treat co-workers and leadership with respect.
* Motivate and empower the team to maximize outcomes and maintain a positive work environment.
* Adheres to and models company standards, processes, and protocols.
* Lead by example and champion Valora’s vision, mission, and values
* Other duties as assigned.
*Education/Qualifications:*
* Bachelor's Degree in Healthcare Administration, Business Administration, or Management Substitutions
* Master's Degree in preferred
* Bilingual in English and Spanish is highly preferred
* 7+ years’ experience in management, specifically in the healthcare industry
* 5+ years’ experience with MRA Coding and Clinical Documentation
* Knowledge of EMR systems - eClinicalWorks (eCW) experience is required
* Proficient in Microsoft Office 365 (Outlook, PowerPoint, Excel, Word)
* Understanding of and adherence to expectations under CMS Fraud/Waste Abuse, OSHA, and HIPAA
* Must have effective written, verbal communication, and interpersonal skills
* Ability to complete assigned duties in a timely and proficient manner
* Ability to communicate with others effectively in a concise manner, in order to bring issues effectively to a resolution
* Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette in dealing with others
* Ability to handle confidential information with discretion
* Strong analytical skills with attention to detail
* Ability to learn new procedures and adapt quickly to change
* Innovative, motivated, organized, and team player
* Follow through with commitments
* Ability to work independently
* Proactive and self-starter.
*EXPERIENCE*
Required
* 7 - 10 years in the Healthcare Industry
* 5 - 7 years in Management
* 5 - 7 years in Risk Revenue
*LICENSES AND CERTIFICATIONS*
Required
* AAPC, Certified Professional Coder (CPC)
Highly Preferred
* AAPC, Certified Risk Adjustment Coder (CRC)
*Skills:*
* CMS Regulations
* EHR (eClinicalWorks)
*EEO Statement: *Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States.
Job Type: Full-time
Benefits:
* 401(k)
* 401(k) matching
* Dental insurance
* Disability insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Health savings account
* Life insurance
* Paid time off
* Referral program
* Retirement plan
* Vision insurance
Medical Specialty:
* Geriatrics
Schedule:
* 8 hour shift
* Monday to Friday
Application Question(s):
* What is your desired salary?
Education:
* Bachelor's (Preferred)
Experience:
* eClinicalWorks: 7 years (Preferred)
* Risk Revenue: 5 years (Preferred)
* Medical documentation: 5 years (Preferred)
* Medicare Compliance & Regulations: 5 years (Preferred)
* CPT coding: 4 years (Preferred)
* EMR systems: 5 years (Preferred)
Language:
* Spanish (Preferred)
License/Certification:
* AAPC or CPC (Preferred)
* CRC (Preferred)
Ability to Commute:
* Orlando, FL 32812 (Required)
Ability to Relocate:
* Orlando, FL 32812: Relocate before starting work (Required)
Work Location: In person
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