Data Quality Manager OC Anaheim, CA
The Data Quality Mrg (DQM) is responsible for the Mgmt of teams supporting local & region-wide initiatives. The Mrg serves as the key compliance advisor to the medical center staff, ensuring optimal documentation & supporting Nat-l & reg-l compliance plans to ensure fed, state & other regulatory standards, clinical strategic goals, & HEDIS goals are met. This position is expected to be the primary coding & doc consultant & an ongoing resource to the Area Medical Dir, Medical Group Admin, Associate Medical Group Admin, Asst Medical Group Admin, physicians, non-physician providers, KP HealthConnect (KPHC) support staff, compliance auditors, & other staff. The DQM will function as a mediator on complex coding issues & will work w/reg-l & medical center representatives to find issue resolution. The DQM is responsible for overseeing the synthesis of local & reg-l audit findings to provide actionable feedback on areas for improvement.
- Supervise & develop staff w/in the assigned functional area.
- Coach & develop employees according to their strengths.
- Create a team environment & delegate tasks appropriately.
- Lead strategic planning & manage projects to meet organizational initiatives.
- Oversee daily operations including developing, training, & monitoring the productivity & performance of auditing & other assigned staff.
- Manages & resolves human resource, labor relations, employee & Dept safety,& risk Mgmt issues.
- Oversee & manages budgets & resource allocations.
- Provide on-boarding & orientation for new employees.
- Manages & ensures continuous improvement of services & operations by designing & implementing systems, processes & methods to evaluate & improve effectiveness.
- Develop & maintain collaborative relationships & communications w/ administrative & clinical staff to share pertinent info on documentation, data collection & AUDIT operation systems.
- Prepare auditing analysis to identify trends, patterns, &/or system issues that may contribute to coding & documentation deficiencies & risk areas.
- Make recommendations to leadership regarding steps to alleviate deficiencies (such as training needs, monitoring processes,& formalized procedures).
- Oversee communication of quality assurance results to providers, the appeal process if appropriate, & required corrective actions.
- Communicate lack of corrective action to medical center leadership as needed.
- Assist medical center & Reg-l leadership in the development & implementation of policies & procedures for operational processes & encounter charge/data capture.
- Coordinate the development, implementation, completion, follow-up & evaluation of effectiveness of corrective action plans as required.
- Identify new methods of increasing efficiency & improving processes.
- Work w/ leadership to implement approved departmental changes.
- Participate in DQM, Chief &/or Reg-l Committees, MD Liaison, & Charge Capture meetings, initiatives & tasks as requested.
- Collaborate w/Nat-l Compliance Office, KP Health Connect (KPHC), long term support,& physician champion workgroups to resolve local coding & compliance issues.
- Organize, develop, facilitate & implement actions of the medical center AUDIT Oversight Committee (committee members include: MD Liaisons, Champions, Medical Dirs, & AMGAs).
- Demonstrate flexibility & willingness to adjust to changing work environments.
- Exhibit strong work ethic by consistently producing high quality, accurate & thorough work products.
- This job description is not all encompassing.
- Minimum three (3) years of coding experience.
- Minimum two (2) years of supervisory experience.
- Bachelor's degree in finance/business, medical records technology, health services administration, or nursingOR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Certification in one (1) or more of the following:
- Certified Professional Coder (CPC), or
- Registered Health Information Administrator (RHIA), or
- Registered Health Information Technician (RHIT), or
- Certified Coding Specialist (CCS), and/or Certified Coding Specialist - Physician (CCS-P).
- Proficient in team building, conflict resolution, group interaction, project management, and budget management required.
- Knowledge of CMS rules and regulations and current coding resources, including CPT, ICD-10, HCPCS, fee schedule and HCCs.
- Proficiency in Microsoft Office (Excel, Word, PowerPoint, Access and Visio, etc.).
- Strong interpersonal skills, including the ability to establish and maintain effective relationships with providers, leadership, senior administrators, colleagues and compliance auditing staff.
- Excellent written and verbal communication, facilitation, and presentation skills.
- Must be available to work flexible days and hours.
- Must be able to travel between all medical center facilities if required.
- Position may include assignment to various medical centers and/or regional offices.
- Must be able to work in a Labor/Management Partnership environment.
- Experience using electronic medical record/health record systems such as EPIC or other comparable systems is desired.
- Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex healthcare issues (Examples are: 3M, Medicare Fee Schedule Data Base, National Correct Coding Edits, CMS website, Ingenix Encoder) Medical center operations and/or clinical experience are highly desired.
- Specialty coding certification is highly desired.
- Certification in Healthcare Compliance is highly desired.
Primary Location: California,Anaheim,East Street Warehouse 1011 S. East St.
Scheduled Hours (1-40): 40
Working Days: Mon, Tue, Wed, Thu, Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Manager with Direct Reports
Job: Medical Records
Public Department Name: Clinical Documentation and Audit Operations
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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