Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package. Position Summary
Under the guidance of the Director of Health Information Management, the Manager, Health Information Management will support internal operational initiatives at Commonwealth Care Alliance (CCA) and oversee Health Information Management which includes medical records management and provide support in the clinical documentation improvement efforts. The Manager of Health Information Management will work effectively in a cross-functional manner with the Quality Team, CCA Clinical Operations Team, HR, Clinical Team Lead Managers, Administrator, and Educational Director to ensure the processes in place support CCA’s Care Partners and CCC primary care sites. The Manager of Health Information Management maintains an environment that promotes responsibility, accountability, collaboration and professional growth within the team environment for all off CCA and CCC. The Manager will serve as a primary resource to the Team Leads and team members in evaluating medical records housed either at CCA or in external EMR systems to ensure completeness, accuracy.
The manager will oversee the medical record to external providers release process and monitor volume and provide early identification and intervention for any identified issues negatively impacting this process. The Manager facilitates the entry of the HEDIS measures into CCA’s electronic medical record (EMR). The Manager of Health Information Management will work both independently and in conjunction with the Director, and Director of Education in advising CCA internal departments and CCA’s primary care sites on Medicaid and Medicare documentation requirements. The Manager will have oversight of processes for properly releasing medical records, requesting and storing medical records from external sources, and accessing medical data in external EMRs of partnering organizations. Key Responsibilities
Minimum Education, Knowledge, Skills & Abilities
- Assists with the implementation of policies and procedures ensuring consistent application for all processes.
- Ensures that the duties and responsibilities assigned to direct reports are carried out in an efficient, systematic, and cost-effective manner.
- Reviews ongoing processes to ensure the processes are correct, clear and easy to follow
- Identifies any CCA changes that could impact current workflow and identifies method to address and resolve.
- Presents workflow changes to Director to discuss and develop an implementation plan if indicated.
- Evaluates medical record data entry by Clinical Documentation Support Assistants (CDSA), to optimize reimbursement and ensure adequate collection of clinical quality data;
- Distributes monthly MDS reassessment list for SCO and One Care to the team spreadsheet to facilitate record requests and EMR access date import.
- Receives and analyzes monthly reports to assess team productivity, new member census and trends.
- Completes Monthly random data entry reviews of team members to ensure that work is done in a timely and correct manner. Ensure that documents are saved correctly for easy reference by whoever needs to access this information on the member in eCW.
- Directs standard operating procedures and processes for the Health Information Management to ensure HIPAA compliance and aligned with CCA’s policies regarding medical records management, including release of records, obtaining records, and accessing external EMRs.
- Responsible for interviewing, hiring, training, coaching and counseling staff
- Conducts performance reviews for clinical staff and submits salary recommendations
- Provides technical guidance to primary care site in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation or data entry into eCW selection, documentation, procedures, and requirements
- Develops and makes presentations to staff, management, and other groups as required.
- Bachelor’s degree preferred with 2-4 years of management experience in a health care setting.
- Knowledge of Medicare risk adjustment documentation requirements.
- Ability to create and maintain strong relationships with the Clinical Staff and confidently discussing clinical diagnoses.
- Up-to-date clinical knowledge to be able to efficiently and concurrently review medical records, understand clinical picture of the patient condition, and identify opportunities for improved documentation.
- Mentor, teach and support the student/employee.
- Effective interpersonal and communication skills.
- Leadership skills.
- Decision making and problem-solving skills;
- Positive professional attitude;
- Interest in professional growth;
- Ability to provide feedback effectively to clinicians and department staff
- Ability to provide accessibility to employees for completion of projects/objectives
- Proven experience working both
- Knowledge of Medicare risk adjustment documentation requirements