Sr. Director Coding and Documentation

Job Summary

As a key member of the Coding and Documentation leadership team, this position will report to the CFAO, and assume a strategic role in the oversight of the company's coding, documentation and audit/education departments to support both the owned clinic and affiliate business. The Senior Director provides leadership and direction to the team, as well as collaborates with senior leadership to ensure that all coding and documentation functions are aligned with compliance and clinical requirements and are in accordance with the mission, vision, values and policies of Cano Health

Essential Duties & Responsibilities

·         Models Cano Health's core values and leadership essentials to lead and build a highly effective team, with associates who will provide quality results.

·         Provides experience-based guidance to managers and staff regarding coding guidelines, educational programs for both coders and clinicians and understands Medicare Advantage guidelines and processes

·         Drives strategic initiatives using analytical tools for both the owned-clinic and affiliate businesses.

·         Closely monitors coders work quality and productivity.

·         Ensures physician and coder documentation audits are completed timely and effectively and that corrective actions/education is provided, as needed.

·         Work collaborately with clinical and operations leadership to drive annual education programs, disease prevalance programs and preventative screening protocals.

·         Supports execution of the strategy for compliant Medicare Advantage risk adjustment utilizing CMS and HCC models.

·         Manages delivery of the risk adjustment business process and serves as a subject matter expert for risk adjustment processes and related regulations.

·         Supports department budgeting and forecasting, goals, and initiatives.

·         Maintains key performance indicators (KPIs) and reports to ensure optimal performance and responsiveness to internal and external stakeholders.

·         Supports strategy to improve accuracy and completeness of revenue from CMS through prospective assessments and retrospective chart reviews.

·         Work collaboratively with contracted health plans on documentation and audit requests, as needed.

·         Work with Revenue Cycle Management team and outsourced vendor to address any coding issues identified.

·         Business owner of the internally developed pre-review coding workflow tool and subject matter expert, as needed, with EMR vendor related to coding workflows.

Supervisory Responsibilities

·         Oversee and lead department managers/team leads (Pre-Review Coding, Coding Education, Coding Audit & MSO Coding).

Education & Experience

• 10+ years of experience in Medicare Advantage coding/documentation
• 7+ years of leadership experience
• Experience in primary care
• CPC, CRC, and/or CPMA certifications

Education Requirements

Required/Preferred

Education Level

Discipline

Required

Bachelor's Degree

Knowledge, Skills & Proficiencies

• Leadership skills to effectively direct work and support to other department professionals
• Ability to communicate professionally with all levels of leadership
• Excellent written and oral communication skills, technical writing skills for development, implementation and maintenance of documentation and presenting to leadership
• Communicate and maintain the integrity of sensitive, detailed information
• Understanding of system applications including but not limited to: Microsoft Office, medical terminology and medical procedures and services as pertaining to the role
• Ability to assess work and patient needs related to department practices, procedures, computer systems with materials to target these needs
• Knowledge of the medical field and practices
• Skill in operating technology and other IT systems

Physical Requirements

This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, and walk. The incumbent must be able to work extended and flexible hours and weekends as needed. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing

Travel Requirements

Amount of Expected Travel

Details

Yes

25-50%

Will involve driving/traveling to Medical Centers in all company regions & expanding markets

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time.