ACO Clinical Documentation & Quality Improvement Specialist

Why This Role is Important to UsThe Clinical Documentation Improvement Specialist will facilitate improved quality, accuracy and completeness of medical record documentation and quality gap closure by conducting proactive reviews of patients’ electronic medical records and other data sources. This review will occur in advance of scheduled patient office visits to ensure all gaps in care are identified and addressed by the provider during that visit. In addition, this role may perform audits and medical charts reviews. All duties will be performed in accordance with ICD-10 coding guidelines, internal protocols, and CMS guidance.What You’ll Be Doing

Conducts proactive review of the medical record to include:

Review diagnosis coding

Identifying co-morbidities and complications

Capturing all appropriate secondary diagnoses

Ensuring timely, accurate, and complete documentation of clinical information used for measuring and reporting provider outcomes.

Works in collaboration with our Coding Department to:

Provide education to Providers and supporting clinical care teams on documentation, coding changes, and compliance Issues

Monitor changes in laws, regulations, rules, and code assignments that impact documentation and reimbursement

Partners with ACO Care Coordinators to review the medical record and identify Quality and Care Gaps prior to the patient visit and facilitate communication

Develops relationships with providers and communicates guidelines and requirements of

Risk Adjustment Payment System to ensure correct coding and documentation

Maintains knowledge of related regulations and requirements supporting CMS Risk Adjustment

Data Validation

Partners with ACO HCC Coders and leadership to complete and tracks all Patient Assessment

Forms as requested by health plans.

Handle other duties as required or assigned, as it pertains to population health activities.

What We’re Looking ForEducation and Experience

Associates’ degree in Nursing or higher required; Bachelor’s Degree in Nursing Preferred

Current RN license in good standing required

Recent clinical experience (minimum 5 years), preferably in primary care setting

Experience with EMR, preferably Cerner

Certified Risk Adjustment Coder or Certified Professional Coder through AAPC or CDI or CCS

certification through AHIMA, or ability to obtain certification within 6 months from date of hire

1+ years recent experience ICD-10 coding with strong attention to detail and high accuracy

rate preferred

1+ years of recent Risk Adjustment / HCC Coding experience preferred

Knowledge, skills and abilities:

Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint)

Working knowledge of health plan/insurance terminology and concepts

Excellent professional judgment and decision making ability

Flexibility and willingness to work both independently as and as a team member in a developing

program

Strong organizational and prioritization skills

Excellent oral and written communication skills adaptable to individuals with varied levels of

understanding at all levels of the organization

Highly developed problem solving and deductive reasoning skills

Dependable, self-directed, and diplomatic

Able to participate collaboratively with all members of the care team

Knowledge of HEDIS, abstraction concepts, Medicare Risk Adjustment and CMS risk

adjustment guidelines preferred

Must meet deadlines and produce accurate work product

Must be able to handle multiple tasks at the same time and work well independently

About UsCentral Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast Maine. CMHC's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital, and Rumford Hospital. CMHC also supports Central Maine Medical Group, a primary and specialty care practice organization with a presence in 17 Maine communities. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center, Long-Term Care facilities in Auburn and Rumford, Topsham Care Center, and other high quality clinical services.