REPORTING: Senior Vice President, Clinical Reading Services- (based in USA)
POSITION SUMMARY
The VP of Clinical Reading will lead the development, coordination and management of the Philippine based Clinical Reading Division including Abstraction, Production and Client Relations as required. The incumbent will directly supervise and provide technical and leadership expertise to division staff to assure target quality and production levels of coded and abstracted clinical data within the Company databases. He/she will work with senior management to improve work flow processes that will facilitate coding/abstraction accuracy and data quality.
This position will direct and develop multi-level projects to improve and support business goals and critical business strategies. This position will report directly to the Senior Vice President of Clinical Reading Services based in the US.
QUALIFICATIONS:
- 10 to 15 years in a combination of hospital/physician office coding and supervisory work including ICD-9-CM diagnostic/procedure coding, CPT, Evaluation and Management, DRG & APC systems, and Medicare/Medicaid rules/regulations. Experience with HEDIS and CMS HCC Risk Adjustment coding and data validation
REQUIRED KNOWLEDGE, SKILLS & ABILITIES
- Extensive knowledge of medical billing and payment methodologies, including all coding guidelines for ICD-9, DRGs, APCs, emergency department, and/or evaluation and management coding (demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements preferred)
- Knowledge of multi-specialty physician practices and academic settings (inpatient and outpatient)
- Proven medical background in anatomy, physiology, pathology, medical terminology and pharmacology
- Ability to deliver in a high production environment
- Ability to make administrative and procedural decisions and judgments
- Ability to foster a cooperative work environment
- Ability to plan, develop and coordinate multiple projects
- Skill in budget preparation and fiscal management, conflict resolution and/or mediation skills;
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
SUMMARY OF RESPONSIBILITIES
- Directs the coding/abstraction, production and quality assurance activities (as required) of the Clinical Reading Division.
- Responsible for performance management of teams and individuals based on company standards for productivity and quality.
- Develops detailed requirements and documents for all processes within the Division.
- Maintains oversight of certification requirements for the various disciplines within the division’s departments and monitors professional information for up-dates and changes in professional standards.
- Develops and updates enterprise-wide reports.
- Trouble shoots and collaborates with other managers to problem-solve and advance the processes of the division and the Company as a whole.
- Reports progress, obstacles, etc. to the Senior Vice President on a regular basis.
- Interacts regularly with executive team and individual department heads. This includes working directly with the broader US based Operating and Clinical Reading Teams.
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