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RN Quality Ambulatory Care Coordinator
1 month ago
**Overview**The RN Quality Ambulatory Care Coordinator is responsible for supporting the quality initiatives of the clinically integrated network. These functions include: Auditing medical records for qualifying documents that meet requirements to close gaps in care. Accessing multiple care management and payor applications to capture and submit documentation and claims information related to patient visits and services. This role works closely with providers and practice staff in the clinically integrated network (CIN) to communicate and promote best practices for billing, coding, documentation, and improved patient outcomes. RN Quality Ambulatory Care Coordinators review and share the quality performance of their assigned practices and work closely with Ambulatory Care Coordinators to identify barriers related to quality outcomes.**This position is remote with required local travel.****Responsibilities****Essential Key Job Responsibilities**_The key deliverables include:_+ _Pre and post visit documentation and claims auditing._+ _Validate clinical documentation in conjunction with contracted HEDIS measures and best practices._+ _Access clinical documentation for compliance in accordance with the American Medical Association and the Centers for Medicare and Medicaid Services Coding and Documentation guidelines, regulations of federal and state agencies and third party payers._+ _Participate in external audit requests and special projects as needed._+ _Working with a variety of systems and interfaces to achieve this accuracy_+ _Optimization of reimbursement_+ _Communication with patients and providers in a post-acute setting._+ _Health promotion activities_+ _Identify barriers to quality outcomes/reimbursement and report them to the Quality Manager._+ _Bi-monthly communication with assigned practices__This position will report on the following key result areas and will take steps to recommend intervention in areas demonstrating less than optimal performance:_+ _Audit and project outcomes_+ _Improve reimbursement__Collaboration, organization, and attention to detail are critical skill sets for this position.__Access to sensitive initiatives and patient information may be necessary to perform these job duties; therefore ability to maintain confidentiality is a requirement. It is vital that an individual in this position be capable of good communication skills. It is of the utmost importance that written communication is legible.__The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned._**Qualifications****Minimum Qualifications****Required Education and Experience****BSN required** , Prior experience in direct patient care, care coordination, disease management, managed care. Experience navigating electronic medical records and healthcare claims data.**Required Licensure and Certifications**RN, with current state licensure**Required Minimum Knowledge, Skills, Abilities and Training**5 years of clinical,case management and /or healthcare experience.Experience working with Medicare and Medicaid populations.Strong communication skillsKnowledge and experience with information technologyAbility to work autonomously within a matrix environment/remote workspace.Dependable transportation for required travelExperience in patient education and advocacy.Motivational Interviewing**Pay Range**$30.47 - $44.19 /hourWe are an equal opportunity/affirmative action employer.
