Manager Clinical Programs

Profile

2000 16th St,Denver,Colorado,80202-5117,United States of America

DaVita Integrated Kidney Care (DaVita IKC) is the division of DaVita Inc.

working on our vision to provide quality integrated care to some of the most

medically complex and vulnerable patient populations in the US.

What sets DaVita IKC apart is our focus on creating and delivering an

exceptional experience for our patients, and a special place to work for our

teammates. Together, our more than 600 dedicated Nurses, Care

Coordinators, Nurse Practitioners (NPs) and Business Professionals

manage care for more than 20,000 patients with late-stage chronic kidney

disease (CKD) and end stage renal disease (ESRD), across the US each month.

We\'re on a mission to revolutionize kidney care, with a vision of making

integrated care the standard of care for all renal patients. To help us

achieve our vision, we\'re investing extensively in developing both our

model of care and our team.When you join DaVita IKC, you\'re joining a

compassionate team committed to quality patient care.

Through our commitment to training, growth and relentless quality, we

consistently achieve superior clinical outcomes while giving teammates the

opportunity to excel in an award-winning environment that enables them to

thrive, both professionally and personally.

If this sounds like you, keep reading! You may be a great fit for our

MANAGER, CLINICAL PROGRAMS opening!

General Purpose of the Manager, Clinical Programs:The Manager of Clinical

Programs is responsible for planning and managing the performance of DaVita

Integrated Kidney Care\'s Medicare Encounter Data Submissions (EDS)

processes. Under the direction of the Risk Adjustment team, this Manager

will collaborate with interdisciplinary teams, internally & externally,

to execute on the EDS programs, ensuring accurate Risk Adjustment Data.

* LOCATION: REMOTE, less than 15% annual travel to corporate office(s) *

Essential Duties & Responsibilities:The Manager of Clinical Programs

oversees and monitors the claims & encounters processes, partnering with

cross-functional teams to prevent encounter rejections via root cause analysis

and resolution.

Monitor inbound & outbound encounter process.

Identify & interpret encounter data, submission requirements &

performance metrics.

Oversee research of claims/encounters, for benefits-related issues.

Propose solutions via claims, benefit/contract & provider

configuration, eligibility related errors, etc.

Monitor State, Federal and/or third-party agency submissions,

contractual compliance, & SLAs.

Develop reports (exception reports, standard reports, performance

reports, etc.) & distribute to appropriate departments for error

resolution, follow up & performance monitoring.

Work cross-functionally toward the alignment of internal claims, encounter

edits & external rejections.

Participate in and/or lead projects, across various teams/departments,

to address changes, corrections & updates, assuring encounter submission

accept

Partner with internal & external leadership on encounter status(es) and

the reporting / distribution information that affects encounter process,

submission, and acceptance.

Minimum Qualifications:

Bachelor\'s Degree required, Masters preferred

3 years of encounter experience.

3 years of SQL experience retrieving data, compiling, reviewing,

analyzing, interpreting & ensuring the accuracy of encounter data.

Excellent written & verbal communication skills

Experience in critical problem-solving & advanced troubleshooting, to

drive the resolution of business issues.

Knowledge of ICD10, CPT/HCPC/Revenue codes, CMS1500/UB04 Coding,

& other requirements used to adjudicate claims.

Knowledge of Medicare Return Files, Alternate Submission Methods (ASM)

& payor integration strategies.

Working knowledge of healthcare services & systems, that include facility

and professional level claims for physical and behavioral healt .

Here is what you can expect when you join our Village:

* A \community first, company second\ culture based on Core Values that

really matter.

* Clinical outcomes consistently ranked above the national average.

* Award-winning education and training across multiple career paths to help

you reach your potential.

* Performance-based rewards based on stellar individual and team

contributions.

* A comprehensive benefits package designed to enhance your health, your

financial well-being and your future.

* Dedication, above all, to caring for patients suffering from chronic

kidney failure across the nation.

Join us as we pursue our vision \To Build the Greatest Healthcare Community

the World has Ever Seen.\

What We\'ll Provide:More than just pay, our DaVita Rewards package

connects teammates to what matters most. Teammates are eligible to begin

receiving benefits on the first day of the month following or coinciding with

one month of continuous employment. Below are some of our benefit offerings.

Comprehensive benefits: Medical, dental, vision, 401(k) match,

paid time off, PTO cash out

Support for you and your family: Family resources, EAP counseling

sessions, access Headspace, backup child and elder care,

maternity/paternity leave and more

Company info

DaVita Inc
Website : https://www.davita.com/