Texas Health Resources Clinical Documentation Supervisor in Dallas, Texas
Min. Education required: An associates or bachelor’s degree in nursing from an accredited RN program – ADN or BSN
Min. Experience required:
5 years of related clinical experience to include 1 year experience in Medicare Advantage risk adjustment documentation and coding.
Prior coding experience in a primary care medical office environment.
2 years previous supervisory experience
Disease management and/or patient education experience preferred
•Strong written and verbal communication skills; strong analytical, organizational and time management skills required
•Proficiency in Microsoft Office Word, Excel and Access.
•High level of critical thinking skills.
•Provide risk adjustment audit reviews of THPG physicians medical records using CMS’s guidelines and HCC methodology to ensure accuracy, specificity, and appropriateness of ICD -9 / ICD-10 codes and documentation
• Performs Medicare Advantage provider chart audits to confirm and document appropriate diagnosis coding in compliance with ICD-9/ICD-10 and CMS risk adjustment guidelines to ensure that the medical record is accurate, complete, and specific.
• Will audit all chart content for 24 months previous of the audit date, if the chart has never been audited. Will audit chart content retro the previous audit date if applicable.
• Utilize HCC coding bank to capture, identify, and evaluate any HCC codes that need to be re-documented for the current audit year.
• Responsible for organizing and planning training/education for assigned providers and administrative staff on Risk Adjustment, ICD 9 codes, HHC methodology ensuring that the training is appropriately integrated into the care coordination strategic direction as well as the missions and values of THPG. Nurse will provide both formal as well as individualized training/education on Risk Adjustment guidelines, ICD-9/ICD-10 codes, HCC methodology in compliance with company and regulatory standards to ensure that compliance and optimization is established across the THPG organization
• Will identify areas of documentation/coding that need improvement and organize monthly or as needed training sessions with assigned providers and/or their administrative staff
• During daily review will identify and ensure appropriate handoff for , those patients identified as clinically and chronically complex patients needing additional intervention
• Provide quality audits for targeted quality measures communicating needed measures to the appropriate team.
• Nurse will review for compliance and completion of targeted quality measures required for the management of capitation/risk and ACO population
• Nurse will communicate to the provider specific targeted quality measures that have consistently not been meet for the current year. In addition, the nurse will identify and provide feedback on targeted chronic disease adherence standards that need to be ordered/obtained for the current year
• Nurse will use provider approved standing orders to assist the provider in completing any outstanding quality measures for gaps in care.
• During daily review the nurse will identify and ensure appropriate handoff for, those patients identified as clinically and chronically complex patients needing additional intervention
• Will identify areas of targeted quality measures adherence that need improvement and organize quarterly or as needed training sessions or additional program development to assist providers in meeting quality measures.
Supervise and mentor staff by determining work goals, objectives, and training needs, and track progress.
• Ensure tasks assigned to staff are progressing efficiently and are re-organized as priorities shift.
• Mentor staff in regards to current skills and continued professional development.
• Maintain appropriate level of provider assignments and chart audits
• Oversight and practice of assessing the technical accuracy, specificity, and completeness of provider risk adjustment clinical documentation
• Identify improvement opportunities communicating opportunities to director. Process improvement for team work flow with efficiency and effectiveness
• Tracks and trends program compliance to determine areas of focus for educational opportunities
• Supervisor will be expected to make recommendations to the director for daily functioning of the team and processes
• Remains abreast of all developments in the HCC/RAF coding field. Also, works collaboratively with quality director remaining abreast of developments in quality field.
• Assist with coordination and cross functioning of clinical documentation specialist team with other departments.
Texas Health Organization for Physicians (THOP) is Texas Health Resources' 501(a) not-for-profit health corporation offering employment opportunities for administration staff that service providers of Texas Health Physicians Group (THPG). THOP provides services for member physicians that help them get back to what they do best -- practice medicine. From an affordable electronic medical record to comprehensive practice support services and group purchasing power, physicians and their patients benefit from being a part of THPG.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.