Clinical Coding Improvement Specialist

*Must have valid MA Registered Nurse license*

 

SUMMARY:

The Clinical Coding Improvement Specialist is responsible for documentation improvement and integrity and serves as a liaison between clinical care providers, finance, and billers. This role is also an information and educational resource, providing proactive and retrospective review of health center visits as they relate to ICD-10-CM diagnosis coding and reimbursement. The Clinical Coding Improvement Specialist will audit medical records to ensure completeness, accuracy, and compliance with Medicaid coding and supporting documentation guidelines. This role will be responsible for providing reports on coding and documentation trends to providers and managers. The Clinical Coding Improvement Specialist is a half-time coding improvement position combined with a half-time clinical role as a staff nurse or nurse care manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE:

  • Evaluates medical record documentation for completion to ensure accuracy and compliance to meet Medicaid and ICD-10-CM standards.
  • Compares past and present medical history of each participant to maintain complete and accurate ICD-10 codes for appropriate reimbursement.
  • Reviews medical records prospectively to ensure that the care of the patient is recorded in language that payers can interpret and which accurately and completely depicts acuity of the patient and resources expended.
  • In close collaboration with the billing team, reviews medical records retrospectively, to ensure that accurate ICD-10 codes were selected by the provider.
  • Operationalizes and institutionalizes documentation practice that accurately and completely depicts acuity of the patient and resources expended. All methods adhere to coding compliance guidelines.
  • Serves as a resource for clinical teams to address risk adjustment and medical coding guidelines and updates. 
  • Creates and implements training and development for nursing staff, physicians and mid-level practitioners that addresses documentation issues & variances.
  • Maintains a continuous presence with clinical teams to foster trust, collaborative relationships, and culture of improvement.
  • Reviews bulletins, AAPC website, and periodicals, and attends workshops to stay abreast of current issues and changes in the laws and regulations governing medical coding and proper documentation.
  • Leads continuous improvement efforts to make the work of risk coding and documentation easier, better, faster, and ultimately of higher value to Lynn Community Health Center.
  • Develops capability for Lean thinking and scientific problem-solving.
  • Develops, maintains and improves upon effective and accurate IS systems for managing, tracking, and analyzing annual diagnoses capture rates and overall coding quality.
  • Tracks ICD-10 assignments against national benchmarks to identify documentation variances. Identifies potential solutions, whether general education or targeted interventions, where inconsistencies can be improved upon and rectified.

COMPETENCIES:

  • Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
  • Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
  • Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.
  • Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
  • Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
  • Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
  • Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
  • Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

KNOWLEDGE/SKILLS/ABILITIES:

  • Requires a dynamic person with the ability to work in a fast paced environment;
  • Excellent written/verbal and organization skills required;
  • Must be proficient in Excel and Word skills;
  • Preferred proficiency in Adobe Acrobat Professional;
  • Must be highly organized with excellent attention to detail and clerical accuracy; and,
  • Must be self-motivated with the ability to complete projects independently within established timeframes.

Requirements

QUALIFICATIONS/EXPERIENCE:

  • Associate’s degree required. Bachelor’s degree preferred.
  • License Registered Nurse required.
  • Certificate 1 Certified Professional Coder (CPC) required.
  • Certified Risk Adjustment Coder (CRC) Certificate preferred.
  • 3-5 years related work experience required in clinical practice, primary care or behavioral health experience preferred.
  • Experience with computer systems required, including EMR, web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

  • BS in Nursing with 2 to 3 years of acute care clinical experience.
  • Experience/Education in ICD-9/ICD-10 Coding. HCC or DxCG coding experience.
  • Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications preferred.
  • Experienced communicating with providers.
  • Experienced with electronic medical records systems.

SPECIAL REQUIREMENTS:

  • Up to date immunization and annual TB testing is required;
  • Hepatitis B vaccine and annual flu immunization are strongly recommended;
  • All necessary vaccines are available at no charge at the health center; and,
  • Results of inquiry to Criminal Offender Record Investigation (CORI) must be acceptable under health center

Lynn Community Health Center (LCHC) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, LCHC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation and training. LCHC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of LCHC’s employees to perform their job duties may result in discipline up to and including discharge. 

Job Posting ID #17-077

Hours

Full-Time