Responsible for leading the creation and oversight of the Provider Enablement Clinical Documentation Improvement program offering that will provide standardized physician training in principles of high quality clinical documentation within the provider office setting. Ensures the Clinical Documentation program promotes improved reimbursement, patient care and quality outcomes through high quality clinical documentation that accurately reflects the patient's health status and occurrence of events, and furthers the enablement model roll out across the enterprise.
Primary duties may include, but are not limited to:
Defines the internal program offering and works with health plan resources to ensure appropriate workflow for deploying embedded staff at provider office settings for providers purchasing these enablement services.
Responsible for all Anthem-internal related operations, including the submission of claims modifications to corporate operations, provider education, data analysis, audits and oversees the assigned audit process.
Hires, trains, coaches, counsels and evaluates performance of direct reports.
Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences, health administration); 5-7 years of management experience in a health care environment; 3 years experience with Medicare Risk Adjustment and provider issues (i.e. claims, billing, etc.); or any combination of education and experience, which would provide an equivalent background. AAPC or AHIMA coding certification required. MS or advanced degree in a health care related field (i.e. nursing, health education, health administration) or business preferred. Experience with provider EMR systems preferred.
Title: Director Clinical Documentation Improvement-122844
Location: CA-Costa Mesa
Requisition ID: 122844
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