CDIS MSO Lead

Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care. What We Do: Medicare REACH ACO: We're at the forefront of Medicare innovation. Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients. Commercial MSO: Managing care for approximately 16, 000 patients across North-West/Central Florida. Where We Operate: From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered! Our Services: Hospital Medicine Group: Delivering exceptional care in hospitals. Affiliated Medical Practices: Managing several top-tier medical practices. Insurance Agency: Offering comprehensive insurance solutions. Join us on our journey to better health and value-based care! Job Summary: The CDIS MSO LEAD is responsible for monitoring MSO coding performance across the MSO coding team for Pathways Health Partners Medicare Advantage health plan partners. This includes tracking coder accuracy, productivity, and risk adjustment results by health plan and by provider, and identifying trends that need correction. The CDIS MSO LEAD also provides education to providers and their office staff on their individual coding and documentation performance so that every diagnosis reported is complete, accurate, and supported in the medical record, consistent with CMS risk adjustment data requirements (42 CFR 422.310) and the ICD-10-CM Official Guidelines for Coding and Reporting. It is essential to be available during the providers hours of operation to discuss, educate, and research provider and provider staff questions. The primary difference between the CDIS and the CDIS MSO LEAD is that the Lead monitors team-wide MSO coding performance, delivers provider performance education, and assists the supervising manager with training, organizing, and basic administrative tasks. Role and Responsibilities Position Competencies: Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.Serves as resource and subject matter expert to other staff, providers who are a part of the MSO network, and their staffMay travel to assigned provider locations for ongoing education, development, and relationship management.Reviews and verifies documentation to support diagnoses, procedures, and treatment results.Audits clinical documentation and coded data to validate documentation supports services rendered for reporting purposes.Assigns codes for research and compliance with regulatory requirements utilizing coding clinic guidelines.Attends meetings with each MSO Plan to review performance.Identifies discrepancies, potential quality of care, and billing issues.Researches, analyzes, recommends, and facilitates plans of action to correct discrepancies and prevent future coding errors. Qualifications/Position Requirements: 1. Education: High School Diploma or GED. An active CRC (certified risk adjustment coder) or CPC (certified professional coder) preferred. Other certification may be acceptable with additional years of experience; or a combination of education and relevant experience. 2. Experience: two plus years documentation/coding experience in a healthcare setting 3. Certification/Licensure: CRC/CPC highly preferred 4. Training and Knowledge Required at Time of Hire: Understanding of regulations regarding medical coding and documentation; Administrative responsibilities, professional written and verbal communication, Typing skills. Documented training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and regulation. Why Work for Pathways? Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries, bonuses for all team members, and a benefits package that is second to none. Medical Insurance for Employee and Spouse/Significant Other paid up to 100% by Pathways!Addition of family coverage for dependents at a fraction of the cost25K life insurance for employees 100% paid by Pathways!Increasing Employee coverage or adding spouse/dependents at a fraction of the costVision and Dental Coverage available at a very low cost for employees, spouses, and family401K retirement plan with 100% match up to 4% of annual payPaid holidaysAmple Paid Time Off (PTO) for vacation/sick/personal days We look forward to speaking with you about this opportunity!