Optimize the use of resources in assigned area using proven resource management techniques. Encourage innovation and focus resources, including staff not under direct managerial control, to ensure successful delivery of desired results. Ensure continuous improvement of processes and delivery of results within assigned area. Provide day-to-day managerial oversight for staff responsible for Risk Adjustment coding and Quality/HEDIS activities.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. Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Review of provider office/entity process for appropriate submission of ICD10, CPT, and HCPCs codes according to government and coding guidelines. Oversees the development and implementation of risk adjustment and risk mitigation education related to medical record documentation, risk adjustment, Quality/HEDIS. Conducts specialized provider office visits for provider education on Risk Adjustment and Quality/HEDIS measures. Oversees the Performance of special studies per audits, conducting provider office visits and medical records reviews. Co-ordinates audit and accreditation activities on behalf of the organization.
Serves as a resource regarding government and regulatory audits, accreditation standards, and continuous quality improvement principles. Recommend and/or implements process improvements related to the potential of quality medical care and service. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Manages information that will ensure accurate and efficient projects. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Actively seeks and identifies opportunities for improvement. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS.
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