Cano Health

Compensation

Full Description

It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The QA Coordinator, Coding & Billing QA collaborates extensively with physicians, nursing staff and coding staff to improve the quality and completeness of patient care documentation provided and coded for coordination, abstraction and submission of accurate data required by CMS. Facilitates concurrent modifications to clinical documentation to ensure commensurate reimbursement of clinical severity and services rendered to patients with a Diagnosis Related Group based payer (Medicare, Medicaid). Essential Duties & Responsibilities • Educates coding team on CMS coding guidelines and appropriate Risk Adjustment procedures to ensure adherence to CMS standards. • Build and generate reports from the EMR system. • Review concurrent medical record for compliance including completeness and accuracy for severity of illness (SOI) and quality. • Will coach coders as assigned by regions, providing guidance on their daily workflow activities. • Effectively and appropriately communicates with staff as necessary to ensure appropriate, accurate and complete clinical documentation, as well as prevention of inappropriate coding. • Participate in meetings, including feedback on outstanding issues, presentations for educational opportunities and any other needs identified. • Supports timely, accurate and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. • Communicates with and educates all physician and clinical staff concerning accurate and effective clinical documentation. • Facilitate the overall quality and completeness of the clinical documentation to accurately represent the severity, acuity, and risk of mortality profile of the patient being treated. • Collaborates with data teams to identify any potential gaps related to Risk Adjustment. • Works with the QA team to ensure the proper education is maintained and that the chronic conditions are captured appropriately. Additional Duties & Responsibilities • Knowledge: Prior knowledge with ECW, coding guidelines, Microsoft Office platforms, fluency in English and Spanish (preferred). • Collaborates: Engages with our Cano team, other medical offices, insurance companies and patients to ensure that the best patient care is achieved. Education & Experience • Minimum two (2) years prior coding experience with AAPC/AHIMA certifications • Minimum two (2) years prior QA experience • Proficient in Microsoft Word and Excel • Strong organization, training, and process management skills • Strong collaboration and relationship building skills • Excellent written and verbal communication skills • Ability to learn new tasks and concept. Required/Preferred Education Requirements Education Level Discipline Required High School Knowledge, Skills & Proficiencies • The ability to analyze and interpret the clinical information in the patient’s medical record. • Recognizes opportunities for documentation improvement using strong critical thinking • skills. Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance. • A working knowledge of DRG formulation, Coding Guidelines and Coding Clinic guidance. • Strong written and verbal communication skills demonstrated by the ability to effectively • communicate with physicians and other clinicians. • Knowledge of healthcare regulations, reimbursement, and documentation requirements. • Applies medical terminology and medical procedures to properly evaluate clinical documents. Physical Requirements This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include the ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Conditions Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing Travel Requirements Amount of Expected Travel Details Yes 0-25% Work may involve some driving/traveling to assigned clinics. Tools & Equipment Used Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Join our team that is making a difference! Please see Cano Health’s Notice of E-Verify Participation and the Right to Work post here