DaVita CHAPs Regional Manager in CHATSWORTH, California

CHAPs Regional Manager

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of June 30, 2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately760,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

Weare committed to bringing the benefits of coordinated care to our patients andto taking a leading role in the transformation of the national healthcaredelivery system to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita Medical Group may be the employer foryou.

Overview:

Responsible for the ongoing development, implementation and facilitation of the processes to assure that all pertinent clinical information impacting the risk scoring of Medicare patients is captured and transmitted to health plans. Includes participation in ongoing data mining and analysis, oversight of physician reviewers and the review program, development and delivery of education and identification of opportunities to improve reimbursement through proper coding and documentation. Oversees the general organization and efficient management of the Medicare Comprehensive Health Assessment Program (CHAPs) activities in the region.

Essential Functions:

  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

  • Collaborates with regional management on key physician activities and Provider Relations and IPA liaisons on Comprehensive Health Assessment activities.

  • Interacts closely with central management by collaborating on development of regional programs and disseminating, managing and overseeing central initiatives and data reporting.

  • Interprets and provides feedback of CMS regulations and HCC risk adjustments reimbursement methodology.

  • Ensures dissemination of clinical / reimbursement information to all stakeholders (e.g. Decision Support, reviewers, etc.).

  • Acts as a resource on topics related to the clinical component of Medicare billing and Hierarchical Condition Coding.

  • Identifies educational needs and meets these needs using both internal and external resources.

  • Collaborates in identifying targets for improvement and evaluates the results of interventions.

  • Identifies further opportunities for diagnosis evaluation.

  • Assists in evaluating effectiveness of each activity associated with the program.

  • Evaluates review team performance for productivity and inter-rater reliability.

  • Assists in setting priorities for reviews and interventions.

  • Coordinates the orientation of new reviewers in collaboration with the lead reviewer.

  • Oversees coordination of physician offices and physician reviewer schedules.

  • Monitors physician reviewer productivity and reimbursement.

  • Works with Provider Relations department to facilitate dissemination of information to providers.

  • Tracks and facilitates PCP payments related to special incentives implemented by the leadership team.

  • Monitors physician reviewers’ productivity and quality / productivity incentives.

  • Oversees quality of work provided by administrative support staff.

  • Participates in process improvement projects related to work performed.

  • Orients new staff and provides training to teammates on work processes.

  • Adheres to Universal Precautions at all times.

  • Adheres to safety policies and procedures at all times.

  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.

EXPERIENCE:

Minimum:

  • 3 to 5 years experience in project management, health informatics, operations, and / or Medicare billing.

KNOWLEDGE, SKILLS, ABILITIES:

  • Strong clinical background with both acute care and chronic disease state management experience.

  • Strong Information Technology background.

  • Proficient user of MS Office Suite including intermediate to high-end user of Microsoft Access and Excel.

  • Strong understanding of the principles governing healthcare reimbursement including ICD-10 / CPT coding.

  • Excellent organizational and problem solving skills.

  • Excellent verbal and written communication skills.

  • Ability to effectively interface with staff, clinicians and management.

Primary Location CA-CHATSWORTH - 91311

Req ID: 306617