Job Abstract

Supervise and evaluate the daily work in accordance with departmental and organizational policies. Manage staffing to ensure adequate coverage and optimize productivity. Assign coverage and deploy staff accordingly. Participate in budget development and recommend budgets for areas of oversight. Track spending for areas of oversight. As a subject matter expert on Interqual and MCG guidelines, function as a resource to staff and intervene to resolve issues that arise internally and with payors. Me... more detailsntor staff and support learning opportunities to foster success. Work directly with payors and Managed Care to enhance communication and improve authorization processes. Assist with the management of denials and High Risk cases. Partner with coding leadership to monitor trends and mismatches between CDI and coding and strategize about ongoing process improvement. Ensure Clinical Documentation Specialists and Coders are educated on organizational initiatives and professional trends in practice. Target improvement activities to specific payers, DR - Gs, and teams based on financial and clinical data analysis. Assist in the development and reporting of performance measures to the medical staff and/or healthcare teams; prepare physician specific-data reports. Facilitate change process required to capture needed documentation such as template/forms design. Develop ongoing physician/provider education strategies in collaboration with other Revenue Cycle Departments to promote complete and accurate clinical documentation and correct negative trends. Monitor CDS assignment in 3 M/360 and review Account Validation. Establish and maintain effective internal and external relationships to optimize achieving departmental and organizational goals. Provide information to Case Managers and Clinical Documentation Specialists on organizational initiatives and professional trends in practice. Represent CRM and CDI on organizational committees. Ensure Case Management and Clinical Documentation Improvement activities are in regulatory compliance (JC, CMS). Track clinical, functional, operational, quality and financial data related to CRM and CDI. Collect and analyze data on program efforts and outcomes; identify patterns, trend variances, and opportunities to improve documentation review and process. Implement processes to continually improve performance, reduce denials, and optimize reimbursement. Update Departmental procedures to reflect changes in payor contracts and departmental processes. CN Hospital (Main Campus) (L 002) 111 Michigan Avenue NW Washington 20010