The Manager, Clinical Documentation Improvement (CDI) will be accountable for the implementation and management of initiatives that support the performance objectives of the Clinical Documentation department. As the Manager, you will be accountable for the production and analysis of risk adjustment clinical documentation and reporting and will be the technical subject matter expert associated with the documentation of diagnosis coding integrity. 

The CDI Manager in coordination with Clinical leadership will be responsible for ensuring the CDI team has the education and tools necessary to be successful and compliant in their daily, comprehensive, concurrent record reviews, query initiation, posting and follow up. You will have direct responsibility for managing the coding team, which includes the development of department goals and objectives, recruiting and hiring, and overall team performance. 

This candidate will bring expertise of the risk adjustment documentation, clinical education and will integrate that knowledge with ConcertoCare’s risk-adjustment based business processes, IT programs and capabilities, and quality initiatives to ensure the most accurate documentation of patient diagnoses for ConcertoCare and our partner related organizations. The candidate will bring expertise related to technical specifications associated with the various risk adjustment programs and initiatives, as well as the capability to utilize this knowledge to develop and successfully execute operational processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assess and identify potential provider opportunities for best practice CDI metrics, workflows, and documentation improvement opportunities. Ensure query compliance training and query quality review process established, maintained, and reported. Monitors the performance of CDI program and leads the coding team to ensure alignment with department and organizational goals.
• Works collaboratively with CDI leadership to hold CDI teams accountable for meeting key performance outcome indicators, and operational process metric
• Ensures that 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 and federal levels. 
• Develops and implements provider education strategies and tools, monitoring provider performance, developing corrective action plans, direct provider interventions, and assisting providers that perform below the industry standard of 95% accuracy benchmark.
• Manages a team of coder/ clinicians to facilitate chart review and ensure complete and accurate documentation.
• Drive and mitigate escalation to providers and Medical Directors who require intervention. 
• Facilitate and support the CDI team in provider 1:1 documentation improvement education sessions
• Executes the strategy and capabilities to develop risk management and physician/member initiatives that support provider documentation and coding accuracy.
• Establish productive relationships and clear lines of communication with ConcertoCare leaders and relevant health plan stakeholders.
• Manages other risk related tasks and projects as assigned.

QUALIFICATIONS

• Bachelor's Degree or equivalent experience required.
• Certified Risk Adjustment Coder (CRC), preferred
• Minimum of 3 years of successfully leading and executing a comprehensive prospective risk adjustment program
• Minimum of 6+ years of healthcare industry experience, preferably in the managed care industry.
• Proven track record of working collaboratively with clinical and operational colleagues across the organization. Ability to manage multiple deadlines.
• Knowledge of the Commercial, Medicaid, and Medicare Advantage healthcare plans.
• Advanced proficiency with MS Excel, Word, and PowerPoint.
• Strong written and verbal communication skills.
• Demonstrated ability to communicate ideas clearly and concisely.
• Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities.
• Understanding of Health Plan, Provider Group, and Clinic Operations.
• Experience working in Healthcare Settings/with Clinicians.
• Experience working with IT and database technologies.

Base Salary/ Wage Range $115,000.00 to $122,000.00 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits. 

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. 

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace