Vp Clinical Operations
Current• Lead and mentor a successful, fluent audit team of multiple lines of business within Medicare Advantage, Medicaid, Tricare, and Commercial Health plans.• Collaborate with IT team to develop algorithms for identification of coding/billing focus.• Oversee the claim selection process.• Maintain ongoing close communication with the CEO to ensure targets are being met and/or exceeded and identifying any needs to achieve goals.• Attend and actively participate in State and National… Show more • Lead and mentor a successful, fluent audit team of multiple lines of business within Medicare Advantage, Medicaid, Tricare, and Commercial Health plans.• Collaborate with IT team to develop algorithms for identification of coding/billing focus.• Oversee the claim selection process.• Maintain ongoing close communication with the CEO to ensure targets are being met and/or exceeded and identifying any needs to achieve goals.• Attend and actively participate in State and National Conferences as well as current and potential Client calls to publicly represent DRG Claims Management.• Oversee new and ongoing Project Development for the company. • Identify and communicate with peers and management any areas needing improvement for efficiency.• Monitor/review QA stats and Change rates. • Monitor staff hours/productivity to meet budget goals.• Identify and develop PIP when necessary with Manager of Auditing.• Create and maintain Operations Procedures.• Hire, onboard and conduct training for employees.• Conduct, field questions/comments and mentor Auditors in Weekly Audit Team/Coding Roundtable meetings and provide education. Show less