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Assistant Director Physician Review

Company: Integrated Resources, Inc ( IRI )
Location: West Orange
Posted on: June 24, 2022

Job Description:

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 needs.
  • Responsible for strategically detailing and implementing plans to incorporate review and education to a growing group of employed providers.
  • 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 staff.
  • 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 requested.
  • Works collaboratively with providers and affiliate staff to promote and ensure correct and compliant coding and billing practices.
  • 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 activity.
  • 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 necessary.
  • 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. EDUCATION/TRAINING/CERTIFICATION/LICENSURE:
    • 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 experience preferred.
    • 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 system.
      • 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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