ACO CDIS Manager

Description

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 Manager will monitor the performance, compliance, documentation, and quality of the internal HCC Risk Coders and any outsourced coding team working with the ACO. The ACO CDIS Manager will take lead on coordinating and executing training, organizing, and basic administrative tasks.

Role and Responsibilities

• Assist in transforming practice workflows to ensure accurate documentation and optimized billing based on MEAT criteria and HCC Captures.
• Assist in optimizing EMR functionality across practices to help configure EMR templates and prompts for real-time risk identification and "smart-logic" documentation.
• Operationalize workflows for TCM, CCM, and Chronic Care visits to capture missed fee-for-service revenue and shared savings.
• Implement strategies to ensure billed diagnoses are fully supported by documentation, reducing audit risk at the source.
• Monitors performance, compliance, documentation, and quality for CDIS Outsourcing projects and the ACO HCC Coding team.

Qualifications/Position Requirements:

1. 1. Education: High School Diploma or GED. An active CRC (certified risk adjustment coder) or CPC (certified professional coder) preferred. Other certifications may be acceptable with additional years of experience, or a combination of education and relevant experience.
   1. Experience: Two (2) plus years' documentation/coding experience in a healthcare setting and managerial experience preferred
   1. Certification/Licensure: CRC/CPC highly preferred
   1. 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 regulations.
   1. Age Specific Individuals Served/Responsibility: Adults
   1. Security Measures and Clearance: Up to and including a Level 2 Background - AHCA (may be required)

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 to100% by Pathways!
• Addition of family coverage for dependents at a fraction of the cost
• 25K life insurance for employees 100% paid by Pathways!
• Increasing Employee coverage or adding spouse/dependents at a fraction of the cost
• Vision and Dental Coverage available at a low cost for employees, spouses, and family
• 401K retirement plan with 100% match up to 4% of annual pay
• Paid holidays
• Ample Paid Time Off (PTO) for vacation/sick/personal days

We look forward to speaking with you about this opportunity!