Working Each Day to Make a Difference
At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.
More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.
We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.
- We are a local not-for-profit health plan in Washington State.
- We are committed to keeping Washington families healthy.
- We connect our communities to the health resources they need.
- We provide access to high-quality care for our members.
- We connect and empower our members through technology.
- The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
- Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.
To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org.
Quality, Education & Coding Specialist – Hybrid, WA
POSITION PURPOSE:
Quality, Education & Coding Specialist works collaboratively with clinic and providers for enhancements, training and education for risk adjustment documentation and performs medical record reviews in accordance with HEDIS technical specifications. This position requires demonstrated knowledge, skill, and ability to educate, train and advise clinical staff for process improvements.
This position is also responsible for performing quality medical record reviews, assisting providers and staff in the improvement of clinical documentation and workflows, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records.
PRINCIPAL DUTIES:
- Collaborate, educate, and train clinical support staff and providers on risk adjustment documentation and workflows specific to HCC and CDPS models.
- Ensure compliance with internal coding guidelines, department policies, and CMS risk adjustment coding guidelines, rules, and regulations. Keep current on regulatory and coding issues/best practices including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.
- Audit provider and vendor documentation of ICD-10 codes to ensure adherence with risk adjustment guidelines.
- Perform root cause analysis to identify issues that may contribute to coding, documentation, claims or other revenue cycle deficiencies.
- Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards to providers and staff.
- Provide real-time support for clinical care and HEDIS/Star teams for annual submission.
- Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and history.
- Maintaining productivity level of a minimum of 50 chases/charts per defined period according to policy.
- Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
QUALIFICATIONS:
Education & Prior Related Experience:
- Possess an associate degree or an equivalent combination of education and highly relevant experience required.
- Have current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA required.
- Have current, unrestricted license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) required.
- Possess a minimum of three years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC) and/or Chronic Illness and Disability Payment System (CDPS).
- And a minimum of three years working with HEDIS data including chart review/collection. HEDIS, QRS, or STARs experience.
- Have experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred.
- Have clinical knowledge related to chronic illness diagnosis, treatment and management.
- Have experience working with clinical staff for process improvement; ability to provide education and coaching to clinic staff.
- Have experience with Microsoft Office applications, including Word, Excel and PowerPoint.
Employment Eligibility:
- Candidate has not been sanctioned or excluded from participation in Federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
- Complete and successfully pass a criminal background check
Knowledge, Skills, and Abilities:
- Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs) and Chronic Illness and Disability Payment System (CDPS).
- Knowledge of acceptable medical record standards and criteria in the context of risk adjustment data validation (RADV).
- Advanced, applied knowledge of ICD-CM codes, coding conventions and coding guidelines.
- Proficiency with computer business applications, and a working knowledge of electronic medical record (EMR) software.
- Demonstrated ability to educate, coach and advise clinical staff for process improvement and workflow re-design.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
- Demonstrated organizational, time management, and project management skills.
- Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
- Willingness to be part of a fast moving, and dynamic clinical development team.
- Perform all functions of the job with accuracy, attention to detail and within established timeframes.
- Meet attendance and punctuality standards.
- Strong computer skills and reliable high-speed internet access at home.
- Demonstrate professional courtesy to others and ability to maintain confidentiality.
- Ability to be proactive in problem identification and resolution.
- Ability to work independently.
To apply, please visit: https://www.chpw.org/contact-us/chpw-careers/
We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.
Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!
Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101