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Quality Coding and Documentation Educator Ii
4 months ago
**Job Summary**: Provides training and process improvement efforts across the clinical practices for the development of consistent and comprehensive clinical practices supported by the the Health Plan. Identifies process improvement opportunities associated with the management of risk adjustment initiatives. Investigates current processes, assessing efficiency and accuracy and provides solutions for problems, process improvement, development of training programs, and documentation strategies that support ICD-10 complex terminology for clinical practice operations and management. Serves as a liaison between Clinical Operations and the Risk and Revenue Management team, and facilitates communication between various constituents in order to assist in capturing chronic disease burden of the clinical enterprise patient population.
**Job Duties**:
- Reviews the content of the medical record professional outpatient records to identify all diagnosis codes applicable to the documentation.
- Carefully reviews details of documents such as laboratory findings, radiology reports, various scanned reports, discharge summaries, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses are recorded.
- Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using proper procedure codes as required.
- Using the Encoder software program, determines the codes for all diagnoses.
- Reviews and understands annual mapping of ICD-9 and ICD-10 crosswalk.
- Provides education material to the team to educate physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding.
- Assists in decision making relevant to physician coding education and HCC targeting purposes.
- Works one-on-one with physicians as needed to verify that documentation within the patient’s record is appropriate in order to facilitate accurate and complete coding.
- Assumes a supporting co-educating role with regard to Risk Adjustment Education and other opportunities for internal education team and external identified opportunities.
- Presents with full understanding of reports, presentations, maps and graphs, reflecting the collaboration of external and internal parties, summary and translation of data into actionable information.
- Works with provider sites to define solutions to needs or problem areas, and determines scope of investigation required to obtain solution.
- Interprets and recommends actionable plans using financial and analytical data prepared by risk adjustment analysts.
- Provides consultative support to clinical areas on a daily basis and recommends operational strategies to achieve optimal documentation and coding processes.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
- Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).
**Position Details**:
**Level II - Minimum 1 certification required**
**RHIT**
**CPC**
**CRC**
**CCS**
**Internet requirements**:
***Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:
- 25 MBPS UP
- 75 Mbps DOWN
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