ACO Clinical Documentation & Quality Improvement Specialist

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Central Maine Healthcare
Published
February 5, 2021
Location
Lewiston, Maine
Job Type

Description

ACO Clinical Documentation & Quality Improvement Specialist

Accountable Care Organization
FT
Day shift
Days
Req #: 28121

Why This Role is Important to Us

The 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 For

 

Education 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 Us

Central 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.

OUR PURPOSE & VALUES:
Our mission is to provide exceptional healthcare services in a safe and trustful environment through expertise, commitment and compassion of our team members, with the vision of safe, reliable, high quality care for each patient, every day.
How do we make this happen? By creating and maintaining a culture where our values of compassion, integrity, citizenship, service excellence and community are lived out in observable behaviors during all interactions.
ABOUT CENTRAL MAINE HEALTHCARE:
Central Maine Healthcare (CMH) is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital, and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. 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, and other high quality clinical services.
About Central Maine Medical Center
Central Maine Medical Center (CMMC) located in Lewiston, is a Level II Trauma Center serving Androscoggin County and the surrounding region. "CMMC's Centers of Excellence" include the Central Maine Heart and Vascular Institute, the Central Maine Comprehensive Cancer Center, the Neonatal Intermediate Care Unit, and a Trauma Services Program. CMMC is also the southern Maine base for LifeFlight of Maine, the state's only medical helicopter service. Supported by the latest technologies, CMMC's skilled professionals provide outstanding care delivered with compassion, kindness, and understanding. Learn more at: www.cmmc.org.
About Bridgton Hospital
Part of Central Maine Healthcare, Bridgton Hospital serves the town of Bridgton and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. Bridgton Hospital was named as one of 17 top rural hospitals in the nation for the third consecutive year in 2018.
About Rumford Hospital
Part of Central Maine Healthcare, Rumford Hospital serves the town of Rumford and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. In 2018, Rumford Hospital was named one of 17 top rural hospitals in the nation by the Leapfrog Group; in 2016, it was designated a Pathway to Excellence® organization by the American Nurses Credentialing Center. Learn more at: www.rumfordhospital.org.
Central Maine Healthcare is equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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