Quality Coding & Document Specialist

Description - External
Quality Coding and Documentation Integrity Specialist - PCN Finance Administration
All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Wellness Programs

Our promise to you:
Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind, and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full-time
Shift: Monday - Friday, 8am - 5pm
Location: Remote
The community you'll be caring for:

• Join a team that provides exceptional patient-based care.
• Collaborative teams that work together for a common goal
• Compassionate and supportive leaders ensure work life balance for team members and providers without compromising patient care.

The role you'll contribute:
The Quality Coding and Documentation Integrity Specialist will focus their work on primary care practices and providers. They will be responsible for you using clinical knowledge and understanding CMS coding guidelines to aid and improve the overall quality and completeness of the patient medical record. This role will work with the quality team as well as primary care practices, to perform retrospective reviews of ambulatory clinical documentation to capture the true complexity of the patient. This will include compliant documentation to support Hierarchical Conditions Categories (HCC), ICD-10, medical necessity, and the appropriate Risk Adjustment Factor. Working with the Quality Team is not only the immediate Quality Team, but also working with physicians, advanced practice providers, practice management and staff. This position must understand the clinical Care Gaps for different populations and use provider education and a multi-disciplinary team approach to aid practices and providers in closing them. They will participate in select committees and provide education as needed. This position will also analyze utilization and outcome reporting for trending and opportunities to prioritize and impact compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
The value you'll bring to the team:
• Performs reviews of ambulatory clinical documentation to ensure that the acuity of the patients is accurately depicted. This includes compliant documentation supporting HCC or capturing them, ICD-10, and medical necessity.
• Utilizes clinical knowledge, critical thinking, knowledge of chronic and complex illnesses, and comprehension of CMS coding guidelines to improve the overall quality and completeness of the patient medical record by demonstrating knowledge of documentation requirements and coding guidelines that pertain to ambulatory clinical documentation.
• Pulls data from multiple sources to produce reports related to ambulatory clinical documentation, quality, and value-based care on a recurring basis as well as needed to serve the needs of the PHD's providers and staff.
• Collaboration with the quality team and multidisciplinary teams to develop analytic and process-driven strategies to continually assess and improve the quality of clinical documentation, use of HCC's and Risk Adjustment of patients.
Qualifications
The expertise and experiences you'll need to succeed:
Minimum qualifications:

• Clinical Degree or Certification or equivalent years of experience, 3 years minimum, with comprehensive knowledge and understand of chronic and acute disease conditions, management, and treatment.
• Experience with clinical documentation reviews, risk adjustment, HCC categories, coding, and auditin
• Medical Assistant Certification Required:
• American Association of Medical Assistants (AAMA)
• American Medical Technologist (AMT)
• National Center for Competency Testing (NCCT)
• National HealthCare Association (NHA)
• National Association for Health Professionals (NAHP) for Nationally Registered Certified Medical Assistant (NRCMA)
• American Medical Certification Association (AMCA)
• American Registry of Medical Assistants (ARMA)
• Certification is required to be active prior to employment and must be maintained throughout employment
• Understanding of care gap closure and value-based care
• Understanding of HCCs and RAF
• Understanding of Healthcare and clinical operations, medical terminology, and medical reporting.