Clinical Coding Quality Specialist
At P3 HealthPartners, our promise is to guide our communities to better health, unburdenclinicians, align incentives and engage patients.
We are aphysician-led organization relentless in our mission to overcome all obstaclesby positively disrupting the business of health care, transforming it fromsickness care into wellness guidance.
We are lookingfor a Clinical Coding Quality Specialist. If you are passionate about your work; eagerto have fun; and motivated to be part of a fast-growing organization in LasVegas, Nevada, then you should consider joining our team.
The Clinical Coding Quality Specialist is responsible for working with the P3 Clinical Coding QA Manager to ensure the quality and integrity of codes abstracted or validated by internal coding staff or vendors working with P3 Comprehensive Clinicals department to enable complete and accurate coding compliance with proper medical record documentation. This will include building and managing relationships, processes and audits with vendors that result in accurate and complete submissions to health plans working with P3 Health Partners. S/He will develop and provide training to familiarize new vendors with the company’s business processes, coding policies and systems; track, measure, evaluate and report the status of vendor performance; and ensure the vendors meet or exceed their contractual obligations by delivering quality services as defined by their statements of work (SOW) and service line agreements (SLA’s). Similar metrics and performance standards will be established and maintained for internal P3 clinical coding teams.
- Experienced in risk adjustment coding for the CMS Medicare Advantage populations
- Understanding of clinical decision making and appropriate documentation for code validation
- Organized, with focused attention to detail, process and metric driven
- Technology savvy, with advanced Excel and presentation skills
- Creative and energetic individual able to build and sustain great working relationships within teams and with vendors partnering with our organization
- Willingness to be cross-trained into related functions, such as quality and medical management, within a matrixed, integrated work environment for population health management
- Ability to work independently and collaboratively in a fast-paced team environment
- Excellent verbal, written and interpersonal communication skills
- Dependable, highly motivated team player with a great attitude
- High school diploma or equivalent required. BS in Business or related field or combination of experience and education. Previous vendor contract management a plus.
- Current coding certification through AAPC or AHIMA (CPC, CCS, RHIT), CRC preferred
- Experience and understanding of Medicare Risk Adjustment compliance rules and regulations and coding guidelines
- Experience with coordination and oversight of remote vendor teams
- Able to coordinate with vendors and their teams at various levels to ensure accurate, smooth and timely communication of data between organizations
- Able to meet deadlines, complete projects within scope and budget, with successful outcomes
- Strong written and verbal communication skills to summarize project status and potential corrective actions
- Ability to implement and monitor corrective actions to continuously improve coding integrity and outcomes for assigned populations
- Advanced Proficiency with MS Word, Excel and Power Point
- Ability to manage multiple projects
- Ability to travel
- Understand and summarize salient points of contracts for implementation and project timelines with key milestones
- Breakdown system, people and oversight resources needed for each project
- Develop and deliver training to internal teams and vendors on company and specifically Comprehensive Clinical policies, process and project expectations, as related to the project
- Compliant management and oversight of the delivery of and/or return of protected patient health information (PHI) between vendor and client health plans
- Nurture ongoing relationships with vendors and work to resolve issues, and use good judgement for escalation processes
- Identify and implement efficiencies and/or problem resolution associated with vendor processes without compromising the high quality and integrity of project outcomes while working within the scope and budget of the project or contract
- Perform quality assessments on vendor work, including feedback and education when necessary
- Support programming for multiple markets and business lines
- Cross-training in other departments as needed for high quality patient care and positive impact on population health