Regional Clinical Document Specialist

Regional Clinical Document Specialist - Lead - Hybrid *Days - 40hrs/wk

Shift: Days

General Summary:

The UMHP Lead Clinical Documentation Specialist is responsible for providing work direction to the UMHP Clinical Documentation Specialist (CDS) team in the planning, coordination and upstream education of clinical documentation improvement and clinical revenue optimization for the ambulatory Primary Care site and Specialty Care service line physicians, APPs and staff. The lead coordinator will provide full program management and improve/optimize workflows and processes to support the education and analysis of coding, documentation, revenue optimization, reimbursement excellence, Annual Wellness Visits (AWVs), modifier usage trends/development, portal messaging and CPT/ICD-10 and HCC code usage for UMHP to achieve best in class in ensuring appropriate payment for outpatient professional clinical visits/services, surgeries, procedures and imaging studies. The lead will partner with the medical site and service line leadership to identify gaps and opportunities for revenue capture and assist with implementation of processes in the ambulatory clinical setting. This position will lead the review and delivery of physician and APP clinical documentation and charge capture, provide updates to leadership on Return-on-Investment status and progress of efforts to improve charge capture and maintain a strong collaborative relationship with the Clinically Integrated Network (CIN) and other relevant departments. The lead coordinator will provide partial coordination and project management of the Medical Group and Population Health governance structure, guiding the coordination and evolution of the UMHP Revenue Oversight Committee (UROC) and UMHP Revenue Implementation Committee (URIC).

Requirements:

• Associate degree or equivalent (i.e. medical billing and coding, health information technology/management, health administration, business administration or another related field required).
• RHIT, RHIA, CCS, CCS-P, CPC or other professional HIM coding certificate.
• Five (5) years of medical coding experience in an educational or training and development setting required.
• EPIC or Revenue Cycle Certification a plus.
• Extensive CPT and ICD-10 coding knowledge.
• Demonstrated experience providing documentation and coding education to providers.
• Excellent communication skills (verbal and written) to enable effective outcomes with the diverse complex clinical care teams.
• Ability to navigate the EHR to identify documents or review to provide accurate capture of clinical information.
• Medical terminology and clinical knowledge with the ability to review documentation and determine what documentation is needed to provide accurate medical codes.
• Ability to work independently, self-motivated and an ability to adapt to the changing healthcare environment.
• Demonstrates attention to detail , proficiency in organizational skills and planning with and ability to juggle multiple priorities in a fast-changing environment.
• Proficiency in computer use including Microsoft Office Suite experience.
• Provide support to clinicians on navigating the EHR to make addendums, create SmartTexts and SmartPhrases and utilize templates.
• Possess initiative-taking, strategic, innovating and out-of-the-box thinking.
• Exhibit an understanding of health care administration, health industry trends.
• Demonstrates leadership, independence, responsibility, accountability and good judgment. Ability to think strategically.
• Acts as a self-starter and demonstrate a willingness to take on new and challenging leadership roles, as well as non-leadership projects and deliverables.
• Accepts and respects diversity without judgment.

Essential Functions and Responsibilities:

1. Leads the design, implementation, education and evaluation of tools and resources to assist providers with efficient and effective documentation, accurate coding and revenue optimization and charge capture opportunities. All coding edits and/or revisions including claim submission are the sole responsibility of the HIM and billing teams. All coding education will be approved by Compliance prior to implementation.
2. Provides work direction, monitors progress and regularly evaluates the UMHP Clinical Documentation Specialists (CDS) to ensure effective implementation, prioritization and continued success for all CDS projects.
3. Provides partial coordination and project management of the Medical Group and Population Health’s governance structure Councils, Committees and Offices.
4. Provides leadership, coaching and mentoring to team members. Provides input for coaching conversations, growth opportunities, hiring and annual increases for the department.
5. Leads the facilitation and deployment of the UMHP CDS coding and documentation education strategy and collaboration efforts with the OPWB Associate Clinical Leaders (ACLs) of Positive Practice, as needed.
6. Leads the development of an upstream coding, documentation, charge capture, revenue optimization and reimbursement excellence education approach focused on new departments and emphasizing new specialty areas to increase knowledge and establish sustainable best practices early on.
7. Leads the onboarding process for new physicians and APPs with orientation to documentation, coding and charge capture excellence, establishing a 3-to-9-month check-in/assessment process with all recently onboarded providers ensuring appropriate charge capture check-ins.
8. Leads the communication with Primary Care site and Specialty Care service line leaders, physicians and APPs with regard to clinical documentation and medical coding for patient care services. Facilitates CDS interaction with site/service line provider champions.
9. Tracks ROI and leads the preparation and analyzation of reports (ROI, Revenue Cycle, wRVU, etc.) to ensure operational alignment and buy-in and to provide feedback on provider and coding performance including state of documentation, charge capture and reconciliation.
10. In collaboration with the ACCCs Revenue Optimization & Reimbursement Excellence and UMHP CDS team, identifies ROI, documentation trends and priority areas/pain points to be shared with site/service line leadership to allow for clinician education. Prepares case and specific documentation examples/presentations to share at department meetings.
11. Leads the review of data to prioritize areas of wRVU recovery.
12. Assists with UMHP and department initiatives to improve charge capture and reconciliation.
13. Leads the strategic development of outpatient charge capture optimization (i.e. professional clinical visits/services, surgeries, procedures and imaging studies), and facilitates change processes required.
14. Attends the University of Michigan Medical Group (UMMG) Revenue Oversight/Implementation Committee (UROC/URIC) for learning and alignment on a regular cadence.
15. Identifies educational opportunities to improve and enhance learning. Maintains current with specialty coding updates, work processes, tools, and clinical and administrative applications necessary to perform job functions.
16. Serves as a resource on documentation requirements and ensures compliance with applicable laws and regulations at the direction of the internal audit team.
17. Builds and maintains positive working relationships throughout the organization that enable efficient leadership through projects involving change management or complex cross-departmental collaboration.
18. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.

Requisition #: req10717