|Employer:||Western Washington Medical Group
|Location:||1728 W Marine View Drive, Suite 110 Everett 98201, WA, US
Primary Position Purpose:
The Quality and Clinical Documentation Improvement Specialist will evaluate medical records to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual-Clinical Modification (ICD-9-CM and ICD-10-CM). The position will be responsible to provide technical guidance and education to physicians, medical, and administrative staff regarding coding and medical chart review process and support client compliance with CMS rules and regulations, health plan audit requirements and coding guidelines. The position also assists with the day to day operations of the quality and risk adjustment initiatives.
- Support providers in proper medical record documentation and HCC reimbursement methodology.
- Provide technical guidance to medical management and claims staff in identifying and resolving issues or errors, such as
- Incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines
- Educate and advise staff on codes, documentation, procedures, and requirements
- Identify training needs, prepare training materials, and conduct coaching for physicians and support staff to improve skills in the review and audit of coding quality health data. * Audit client medical record documentation to assess coding accuracy to fulfill regulatory requirements, assess that diagnoses are appropriately documented and supported according to applicable rules and regulations.
- Supervise and/or perform prospective and retrospective coding reviews and other coding activities as required.
- Adhere to official coding guidelines.
- Provide direct service for providers including:
- Scheduling trainings, reviews, reports
- Research and provide courteous, accurate and timely response to inquiries by providers as related to risk adjustment projects and reports.
Education: Nursing school graduate preferred. BSN preferred.
- Possess a current Washington State RN nursing license to practice without restriction.
- Preferred- Possess valid medical coding certification in one of the following areas :
- Certified RN Coder (CRN-C)
- Certified Clinical Documentation Specialist (CCDS)
- Certified Risk Adjustment Coder (CRC)
- Certified Coding Specialist designation (CCS)
- Certified Professional Coder (CPC)
- 3 to 5 years of nursing experience preferred.
- At least 3 years of experience coding ICD-9/ICD-10 CM, and experience in ICD-10 CM in a risk adjustment environment.
- Knowledge of: HCC, HHC, HCPCS and CPT coding guidelines; medical terminology; anatomy and physiology; HCC reimbursement guidelines.
- At least 3 years in CDI QA reviews, pre bill and retrospective.
- Proficient in MS Office applications.
- Strong written and verbal communication skills, including propensity to establish and build strong relationships.
- Strong analytical skills, with attention to detail.
- Dependable self-starter who is motivated to enhance skills and knowledge base.
- Establish priorities, coordinate work activities and perform multiple and complex tasks while working independently under tight deadlines with minimal supervision in a remote setting.
- Strong organizational, project and time management skills.
- Detail oriented and quick to follow instructions and learn new tasks.
- Customer service oriented and relate to all levels of internal and external audiences.
This position does not require the handling of bio-hazardous waste such as needles, syringes, blood and body fluids.
Works inside under normal temperature conditions, with adequate light, ventilation and space. Works mostly with others, occasionally alone. Must expect moderate noise generated from computer printer, office machinery and talking. Must be able to work in a small or confined office space. Interaction is busy, constant and occasionally interrupted. Stress levels may be high. Attend business-related meetings outside of the office. Requires ability to have personal transportation.
Requires full range of body motion, excellent dexterity and eye hand coordination. Includes long hours of sitting at a computer terminal. Some stretching, bending & stooping. Must be able to lift 25 lbs. Must have excellent rationalization skills.
This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced or delegated by management to meet the business needs of the organization.