Quality Coding & Documentation Specialist AdventHealth PHSO Resources

All the benefits and perks you need for you and your family:

Benefits from Day One

Paid Days Off from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its 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

Location: Remote

The role youll 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. They will be responsible for working directly with our Medical Directors, leadership, and stakeholders from other departments on special projects as it relates to quality initiatives. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value youll 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.

Knowledge and deep understanding 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 PHDs 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 HCCs and Risk Adjustment of patients.

The expertise and experience youll need to succeed :

Minimum qualifications:

Healthcare Degree or Healthcare Certification or 3 year of equivalent experience in healthcare system or medical practice

Knowledge of chronic and acute disease conditions, management, and treatment

Knowledge of value-based care

Certified Coder-AHIMA or AAPC or Certified Medical Assistant (CMA)-AAMA

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Quality/Clinical Effectiveness

Organization: AdventHealth PHSO Resources

Schedule: Full-time

Shift: 1 - Day

Req ID: 25027163

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.