The Data Quality Manager (DQM) is responsible for the management of teams supporting local and region-wide initiatives. The manager serves as the key compliance advisor to the medical center staff, ensuring optimal documentation and supporting national and regional compliance plans to ensure federal, state and other regulatory standards, clinical strategic goals, and HEDIS goals are met. This position is expected to be the primary coding and documentation consultant and an ongoing resource to the Area Medical Director, Medical Group Administrator, Associate Medical Group Administrator, Assistant Medical Group Administrator, physicians, non-physician providers, Kaiser Permanente HealthConnect (KPHC) support staff, compliance auditors, and other staff. The DQM will function as a mediator on complex coding issues and will work with regional and medical center representatives to find issue resolution. The DQM is responsible for overseeing the synthesis of local and regional audit findings to provide actionable feedback on areas for improvement.
Essential Functions:
- Supervise and develop staff within the assigned functional area.
- Coach and develop employees according to their strengths and create a team environment and delegate tasks appropriately.
- Lead strategic planning and manage projects to meet organizational initiatives.
- Oversee daily operations including developing, training, and monitoring the productivity and performance of auditing and other assigned staff.
- Manages and resolves human resource, labor relations, employee and department safety, and risk management issues.
- Oversee and manages budgets and resource allocations.
- Provide on-boarding and orientation for new employees.
- Manages and ensures continuous improvement of services and operations by designing and implementing systems, processes and methods to evaluate and improve effectiveness.
- Develop and maintain collaborative relationships and communications with administrative and clinical staff to share pertinent information on documentation, data collection and AUDIT operation systems.
- Prepare auditing analysis to identify trends, patterns, and/or system issues that may contribute to coding and documentation deficiencies and risk areas.
- Make recommendations to leadership regarding steps to alleviate deficiencies (such as training needs, monitoring processes, and formalized procedures).
- Oversee communication of quality assurance results to providers, the appeal process if appropriate, and required corrective actions.
- Communicate lack of corrective action to medical center leadership as needed.
- Assist medical center and regional leadership in the development and implementation of policies and procedures for operational processes and encounter charge/data capture.
- Coordinate the development, implementation, completion, follow-up and evaluation of effectiveness of corrective action plans as required.
- Identify new methods of increasing efficiency and improving processes.
- Work with leadership to implement approved departmental changes.
- Participate in DQM, Chief and/or Regional Committees, MD Liaison, and Charge Capture meetings, initiatives and tasks as requested.
- Collaborate with National Compliance Office, Kaiser Permanente Health Connect
(KPHC), long term support, and physician champion workgroups to resolve local coding and compliance issues.
- Organize, develop, facilitate and implement actions of the medical center AUDIT Oversight Committee (committee members include: MD Liaisons, Champions, Medical Directors, and AMGAs).
- Demonstrate flexibility and willingness to adjust to changing work environments.
- Exhibit strong work ethic by consistently producing high quality, accurate and thorough work products.
- Maintain audit records, work papers, and tools including audit plans, reports of completed audits, and completed corrective action plans in compliance with federal, state, and organizational policies.
- Respond to ad hoc requests and other duties as assigned.
- Maintain an understanding of regulatory issues and updates through seminars, training courses and regulatory literature.
Qualifications:
Basic Qualifications:
- Bachelor's Degree or five (5) years of equivalent experience in Finance/Business, Medical Records Technology, Health Services Administration, or Nursing.
- Certification in one or more of the following: Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), and/or Certified Coding Specialist - Physician (CCS-P).
- Specialty coding certification is highly desired.
- Certification in Healthcare Compliance is highly desired.
- Three (3) years coding experience.
- Two (2) years supervisory experience.
- Medical center operations and/or clinical experience are highly desired.
- Experience using electronic medical record/health record systems such as EPIC or other comparable systems is desired.
- Proficient in team building, conflict resolution, group interaction, project management, and budget management required.
- Knowledge of CMS rules and regulations and current coding resources, including CPT, ICD-9, HCPCS, fee schedule and HCCs.
- Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex healthcare issues preferred. (Examples are 3M, Medicare Fee Schedule Data Base, National Correct Coding Edits, CMS website, Ingenix Encoder)
- Proficiency in Microsoft Office (Excel, Word, PowerPoint, Access and Visio, etc.).
- Strong interpersonal skills, including the ability to establish and maintain effective relationships with providers, leadership, senior administrators, colleagues and compliance auditing staff.
- Excellent written and verbal communication, facilitation, and presentation skills.
- Must be able to work in a Labor/Management Partnership environment.
- Must be available to work flexible days and hours.
- Must be able to travel between all medical center facilities if required. Position may include assignment to various medical centers and/or regional offices.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.