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Quality, Education

3 months ago

Seattle, Washington, United States Chpw Full time

Who we are
At Community Health Plan of Washington, we embrace diversity and equality in our workforce. We value all applicants and do not discriminate based on any protected characteristics. Our commitment is to:

  • Apply an equity lens to all our work.
  • Reduce health disparities.
  • Become an anti-racist organization.

About the Role
We are looking for a Quality, Education & Coding Specialist to work closely with clinic staff and providers. You will focus on enhancing risk adjustment documentation and conducting medical record reviews to align with HEDIS technical specifications.

This role requires expertise in educating clinical staff for process enhancements and ensuring compliance with coding guidelines.

To be successful in this role, you:

  • Must have an Associate's Degree or equivalent experience.
  • Need current Coding Certification through AAPC and/or AHIMA.
  • Must hold an unrestricted RN or LPN license.
  • Should have at least three years of coding experience, specifically in Medicare and Commercial Risk Adjustment.
  • Must be proficient in HEDIS data and have experience with RADV.
  • Need clinical knowledge related to chronic illness.
  • Should be skilled in providing education and coaching to clinical staff.
  • Must be experienced with Microsoft Office applications.

Essential functions and Roles and Responsibilities:

  • Educate and train clinical support staff on risk adjustment documentation.
  • Ensure compliance with coding guidelines and regulations.
  • Conduct root cause analysis to improve documentation and coding processes.
  • Offer coding support and education to providers and staff.
  • Provide real-time support for clinical care teams.
  • Maintain accurate records of chart audits and reviews.

Knowledge, Skills, and Abilities:

  • Understanding of reimbursement principles and risk adjustment models.
  • Proficiency in ICD-CM codes and coding conventions.
  • Ability to educate and advise clinical staff for process improvement.
  • Strong communication and organizational skills.
  • Proactive problem-solving and time management abilities.

Note:
If you feel you don't meet all qualifications, remember that diverse strengths are valuable. We encourage all interested applicants to apply.

Criminal History:
Applications with criminal backgrounds will be considered on a case-by-case basis.


Compensation and Benefits:
This position offers competitive benefits and compensation based on qualifications and experience.

CHPW provides a range of benefits for Full and Part-time employees and their dependents.


Sensory Requirements:
Various sensory abilities are necessary for this role.


Physical Requirements:
The job involves extended periods of computer use and physical tasks.


Mental Requirements:
Strong cognitive capabilities and conflict management skills.


Work Environment:
Office-based role with considerations for environmental exposure.


We are an Equal Opportunity Employer and value diversity in our workforce.