Responsible for leading the quality documentation and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD-10 codes).
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation.
Develop and deliver clinical focused training on advance coding and documentation while incorporating coder feedback.
Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation.
Develop performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment.
Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures.
Develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success.
Participate in peer review of medical documentation for completed visits notes as well as patient profile information in EMR.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Current, active, valid, and unrestricted nurse practitioner (NP) or PA license in applicable state(s) required.
Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
Requires experience with CMS Risk Models.
Previous management/supervisory experience with direct reports is preferred.
HEDIS experience is preferred.
Experience with clinical data/documentation integrity is preferred (CDEO or CDEI).
Prefer AAPC Certified Risk Adjustment Coder (CRC) certification.

Manager, Clinical Performance & Quality – Nurse Practitioner / Physician Assistant

Key skills