AdventHealth Corporate

All the benefits and perks you need for you and your family:

·    Benefits from Day One

·    Career Development

·    Whole Person Wellbeing Resources

·    Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift: Monday-Friday

Job Location: Hybrid - Orlando, FL

The role you’ll contribute: 

The Director of Clinical Documentation Integrity (CDI) Education is responsible for developing and operationalizing provider education programs to improve provider coding and documentation. Duties will include, but not be limited to, improving provider Hierarchical Condition Category (HCC) addressed rates, improving physician engagement, improving coding accuracy and specificity for coding in the CMS and HHS Risk adjustment model, and creating system wide outpatient physician coding and documentation education curriculum. This position will directly supervise the CDI Education team and will report to the Executive Director of Clinical Documentation Integrity. The role will be responsible for collaborating with key stakeholders within the Population Health Division, AdventHealth Primary Care Network, AdventHealth Well 65+, and independent providers within AdventHealth networks to influence and execute corporate strategies around Clinical Documentation engagement and understanding. The Director will identify business strengths, weaknesses, key issues, and develop strategies and plans needed to facilitate change. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served. Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles. Specific age groups that are served by this position are circled: Neonate, Infant, Pediatric, Adolescent, Adult, Adult/Geriatric. 

The value you’ll bring to the team:

1.     Develops education plans for members of the patient care team, including medical staff, on documentation guidelines on an on-going basis.

2.     Develop the business plan and staffing models to support in office education, coding initiatives & cost-effective Risk Adjustment operations.

3.     Foster close relationships with provider groups in the AH networks, AH Well 65+, and AH Primary Care Network that led to increased engagement and improved education around coding.

4.     Meets directly with providers and / or medical group leaders to address a lack of engagement, opportunities to document the most accurate specificity, and to educate on the financial and clinical impacts of proper documentation.

5.     Support team of Risk Adjustment Coders to review clinical documentation and coding during ambulatory encounters to determine opportunities to improve physician documentation and communicate identified opportunities to the physician.

6.     Lead the development of a risk adjustment communication strategy for internal and external stakeholders, develop training programs, educational materials, and corresponding delivery channels.

7.     Maintains knowledge of coding and billing rules and regulations to ensure that the documentation in the medical record supports appropriate reimbursement.

8.     Assures ambulatory and payor coding/documentation compliance with Federal and State regulatory bodies.

9. Collaborate with Medicare STARS teams to include education on STARS ratings for Medicare products (including HEDIS, CAHPS, HOS).

10.  Develop, train and mentor staff members.

11.  Collaborates with coding staff to develop standard coding guidelines, policies and procedures.

12.  Complies with all relevant laws, rules regulations and accreditation standards and requirements.

13.  Complies with HIPAA regulations.

14.  Assist with PHSO stakeholders on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance.

15.  Ensures safe care to patients, staff and visitors; adheres to all PHSO policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

16.  Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

The expertise and experiences you’ll need to succeed:

KNOWLEDGE AND SKILLS REQUIRED: 

·       Extensive knowledge of CMS-HCC and HHS risk adjustment models.

·       Demonstrated ability to work effectively with physicians and administrators.

·       High level of interpersonal and communication skills necessary to establish rapport with physicians and other healthcare providers.

·       Ability to engage providers with clear communication around coding accuracy opportunities and performance results.

·       Effective computer skills, particularly Microsoft Office Outlook, Word, PowerPoint and Excel.

·       Outstanding collaborative skills.

·       Basic knowledge of all aspects of typical health plan operations including customer service, network management, data exchange, medical management, finance, risk adjustment, regulatory oversight, and compliance.  Advanced knowledge in at least two of these fields.

·       Strong leadership, communication decision making and organizational skills to positively contribute to business and PHD strategies, customer/stakeholder satisfaction, and the delivery of quality service outcomes in a high matrix-management environment in a large healthcare system.

·       Extensive knowledge of NCQA and HEDIS.

KNOWLEDGE AND SKILLS PREFERRED:

·       Extensive knowledge of the health insurance/managed care industry including products (commercial large and small group, individual, Medicare Advantage, self-funded), market segments, competitive landscape, and applicable state and federal statutes and regulations.

·       Strong Ambulatory Background 

EDUCATION AND EXPERIENCE REQUIRED

·       Bachelor’s degree

·       Five years of Medicare Advantage or ACA market risk adjustment experience working for or in support of Managed Care Organizations

·       At least three (3) years of management experience in a health care provider or payor organization

EDUCATION AND EXPERIENCE PREFERRED:

·       Master of Business Administration or Master of Health Administration

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

·       Certified Coder Certification (CPC, CRC, CASCC, CHTS-TR)

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About AdventHealth

At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.

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