Program Manager

• Provides leadership, oversight, coordination, and subject matter expertise for insights related to Population Health Clinical Integration RSA initiatives
• Collaborates with key stakeholders across the Ministry, including BSMH Population Health, Compliance and Revenue Cycle teams, Ensemble, and BSMH physicians and advance care clinicians
• Oversees prospective, concurrent, and retrospective chart reviews for diagnosis coding accuracy
• Supports payer relationships by coordinating chronic condition recapture and suspect condition validation processes
• Collaborates with plan representatives to obtain and analyze RSA gap data
• Facilitates responses to payer-focused HCC validation requests and communicates missed HCC trends to System Director of RSA for dissemination to clinical leadership
• Monitors payer suspect algorithms for potential internal HCC build improvements
• Partners with BSMH Compliance to deliver accurate HCC coding instruction as part of ambulatory provider training and onboarding
• Conducts medical record reviews and analyzes internal data to identify opportunities for real-time training intervention
• Coordinates and participates in collaborative coding forums to share best practices

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