Assistant Director Physician Review
Company: Integrated Resources, Inc ( IRI )
Location: West Orange
Posted on: June 24, 2022
Summary of Job Function:
- Provides detailed assessment of employed provider practices
review and education needs. Provides detailed assessment of new and
additional provider group practices review and education
- Responsible for strategically detailing and implementing plans
to incorporate review and education to a growing group of employed
- Provides direction and oversight in the development of the
annual Physician Review Work Plan based on yearly billing reports
for employed providers applied to CMS Evaluation and Management
benchmarks, aka the "Heat Map", in collaboration with Lead
- Works collaboratively with the Compliance Department to provide
support in planned Joint Venture research and review, Compliance
Department requested provider documentation and coding review, and
presenting review results and education as required.
- Works collaboratively to provide research, review and education
to providers as per Management request.
- Provides direction and oversight to Physician Reviewers and
Educators in the distribution of provider review assignments.
Ensures equitable distribution of additional provider reviews as
- Works collaboratively with providers and affiliate staff to
promote and ensure correct and compliant coding and billing
- Works collaboratively with Lead staff to distribute follow up
review education needs, audit results, coding references, and other
materials associated with completed reviews of employed providers,
including research, and associated research documentation.
- Prepares detailed reports of review activities.
- Maintains proper computer and written records of all review
- Effectively communicates coding recommendations and reasoning
to medical staff members and others.
- May perform regulatory coding research for Compliance
Department and/or employed providers and affiliate staff.
- Corresponds with AMA, etc. with coding questions as
- May be required to assist in the formation of Corrective Action
Plans for the employed physicians and affiliate staff.
- May be required to perform other related duties.
- RHIA required.
- Must have advanced coding education and training with strong
foundation in E/M coding.
- Prior E/M physician auditing experience preferred.
- Prior supervisory experience and/or coding consultant
- Must have excellent interpersonal, oral, and written
communication skills. Must have excellent organizational and time
management skills. Must be a strategic thinker.
- Coding certification required (e.g. CCS, CCS-P, CPC, COC,
CEMC). RN also encouraged. SPECIAL EQUIPMENT/SKILLS:
- Must be able to utilize a personal computer with Windows and
Microsoft Office software, especially Word, Excel and PowerPoint.
Must be able to utilize the 3M Coding and Reimbursement Software
- Must be able to utilize EPIC, 3 M SoftMed, Cerner, Allscripts
SCM and other electronic medical records systems for remotely
reviewing of medical records.
Keywords: Integrated Resources, Inc ( IRI ), West Orange , Assistant Director Physician Review, Healthcare , West Orange, New Jersey
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