Job Title: Clinical Documentation & Quality Educator
Overview:
We are seeking a dedicated Clinical Documentation & Quality Educator to join our team. This role involves traveling to provider practice locations to educate healthcare providers on clinical documentation and quality measures. The objective is to ensure patients receive comprehensive care for chronic and acute conditions, improving their quality of life and preventing complications. The ideal candidate will analyze performance metrics and patient charts to identify documentation improvement opportunities and collaborate with the Risk Adjustment and Quality team to develop and enhance provider education initiatives.
What You Will Do:
- Conduct educational needs assessments for provider practices and develop customized training plans.
- Travel to provider offices across multiple regions to promote quality care, HEDIS and STARS measures, and accurate ICD coding.
- Collaborate with the Risk and Quality team to develop an annual training calendar and coordinate provider education programs.
- Design and deliver training materials that align with contractual and regulatory requirements.
- Lead individual and group education sessions for providers and their staff.
- Organize training schedules, track attendees, and coordinate all training logistics.
- Engage with medical practitioners to provide feedback on best practices for ICD-10 CM coding and quality measures.
- Stay updated on ICD-10 CM coding and quality guidelines, sharing relevant updates with the team.
- Evaluate provider education programs and suggest improvements to enhance their effectiveness.
- Maintain professional communication with the provider engagement team to analyze and present audit/review findings.
- Monitor expenditures and ensure compliance with budgetary constraints.
- Identify performance issues and collaborate with provider practices to develop improvement plans.
Licenses and Certifications:
- Certified Professional Coder (CPC) or Certified Inpatient Coder (CIC) (Required)
- Certified Coding Specialist (CCS), Certified Risk Adjustment Coder (CRC), or Registered Health Information Technician (RHIT) in ICD-10-CM coding (Required)
- Valid driver's license (Required)
Education:
- Bachelor's Degree in a healthcare-related field or equivalent relevant work experience (Required)
- Master's Degree in a healthcare-related field (Preferred)
Work Experience:
- Minimum of 5 years of experience in HCC coding, working with inpatient and outpatient medical records, including ICD-10 CM coding systems for Medicare Advantage Risk Adjustment.
- At least 2 years of experience in coding and/or clinical documentation education.
- Proficiency in medical terminology, provider reimbursement, ICD-10, HCPCS, and CPT-4 coding.
- Strong planning, organizational, interpersonal, and communication skills.
- Ability to manage multiple priorities and meet deadlines.
- Knowledge of HIPAA and commitment to confidentiality.
- Proficiency in computer applications and electronic medical records.
- Adaptability to work independently and collaborate across departments as needed.