Membership director Jobs in Sioux Falls, SD

Job Type

Full-time

Description

The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding. The Medical Director is responsible for capturing the true clinical picture in a manner compliant with federal laws and the healthcare organization's information privacy practices through identification of coding and physician query opportunities. The Medical Director is responsible for overseeing every chart assigned to their team.

The Medical Director works with the DRG Integrity Specialist to confirm the principal diagnosis and the appropriate Diagnosis Related Group (DRG) of every case in compliance with coding guidelines. This process also involves the Medical Director confirming procedures, dates, and complication or comorbidity (CC) or major complication or comorbidity (MCC) when used as a secondary diagnosis. The Medical Director validates clinical indicators for coded diagnoses, capturing the patient's condition and ensuring the accuracy of the severity of illness and risk of mortality for the patient to illustrate the true clinical picture of the episode of care.

II. PRIMARY JOB RESPONSIBILITIES :

• Provide clinical leadership in an inter-disciplinary team in a professional, knowledgeable, and efficient manner to drive client results, exceed client expectations, and foster client confidence
• Maintain a functional and collaborative relationship with the DRG Integrity Specialist to achieve shared company goals
• Comply with medical and federal guidelines at all times
• Resolve conflicts quickly and professionally
• Stays up to date with medical guidelines, advancements within his or her field, and client-specific criteria
• Responsible for the quality of their teams work by developing and implementing strategic goals related to quality improvement within the tower
• Responsible for generating compliant queries based on appropriate clinical indicators for each diagnosis. Every query must meet all regulatory and reporting requirements
• Work with their manager to review tower analytics, identifying trends and actionable steps to improve opportunity capture rate and drive results for clients
• Work with Senior Management and Compliance Officer to adhere to organizational goals and mission
• Participate in corporate educational activities
• Utilize all technology, tools and resources to enhance performance and will be proficient in navigation of various electronic medical records
• Excel in a fast-paced, rapidly changing environment
• Exceed expectations in performance with regard to productivity and quality of his / her tower work, professionalism, and professional growth
• Take on additional responsibilities and demonstrate leadership at a departmental level
• Performs miscellaneous job-related duties as assigned.

Requirements

III. POSITION QUALIFICATIONS :

Education :

Experience :

Knowledge, Skills, and Abilities :