Coor CIlin Integ Prog HCC at Wellstar Health System (Atlanta, GA)

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How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

The HCC Coordinator, Clinical Integration (CI) Program provides support to both the efforts of the WellStar Clinical Partners, as well as the efforts of the Accountable Care Organization. This position reports to the Director, ClinicalIntegration (CI) Program. The HCC Coordinator collaborates with provider practices and multidisciplinary teams to identify and develop strategies to improve the clinical documentation process for the clinical integration programs of Wellstar Clinical Partners. Analyzes data from multiple sources to support quality, safety, and performance improvement initiatives across the network. Uses statistical and/or data management software programs to monitor and assess clinical documentation, design workflows, and create educational resources for providers and practitioners. He/she will also serve as the liaison between the WellStar Clinical Partners organization, the Accountable Care Organizationmembers, the Clinical Documentation Improvement Department (CDI), and the WellStar Health System Quality and Safety Committee.

Key responsibilities of the role include, but may not be limited to:1. Reviewing and analyzing provider documentation, with an eye toward compliance with CMS rules and regulations and capture of risk adjusting (HCC) diagnoses.2. Conducting HEDIS medical record reviews and audits of clinical documentation for HCC/ICD-10-CM coding to identify coding and documentation opportunities and deficiencies.3. Developing strategies to address discrepancies or inadequacies identified in the clinical documentation process.4. Educating providers and members of the patient care team on clinical documentation guidelines 5. Electronic Health Record (EHR) reviews to assess completeness of clinical information used for measuring and reporting opportunities for coding improvement based on the CMS Hierarchical Condition Category (HCC)risk-adjustment model.6. Quarterly review and modification of definitions, descriptions and coding algorithms related to HEDIS, CMS Medicare Stars and Commercial Value-Based Agreement metrics specifications to ensure accuratecalculations of quality outcomes. In this role, the individual is responsible for the overall administration of the coding specifications for clinical quality metrics within each of our value-based programs. Specifically, he/she will ensure reporting is timely and accurate, validate the metrics collected, and distribute risk adjustment reports to key stakeholders. In addition, he/she will provide education and support regarding Hierarchical Condition Category (HCC) risk-adjustment and clinical documentation for providers, practices managers and quality coordinators within the WCP organization. He/she will serve as a resource to existing or potential physician participants and is a primary contact for physicians who require support, education or workflow/process solutions for clinical documentation and risk adjustment. The HCC Coordinator, CI Program must maintain current awareness of CMS and industry best practices andguidelines, as well as federal compliance rules for documenting diagnoses and procedures for accurate reporting of patient risk scores. This individual will be a key participant in the transformation of WellStar as a preeminent integratedHealth System.

Impact of this role in the organization:The HCC Coordinator, CI Program will also use statistical and/or data management software packages (including 3M|M*Modal) to analyze data, create new metrics and use information to identify WCP best practices andopportunities for improvement.

Required Minimum Education:

Bachelor's degree in management or clinical arena with formal training in health care quality, coding, clinical documentation and/or population health; OR Registered Nurse with quality focus and minimum of four years' clinical experience.

Required Minimum Experience:

Minimum of four years' experience with quality improvement, clinical & quality audits, data analysis and report development; any combination of education/advanced degree and relevantexperience will be considered in lieu of the required experience.

Preferred Experience:

Proficiency in Clinical Documentation Improvement (CDI) or Medical Coding preferred; Candidate would ideally have experience with common Business Intelligence and Data Visualization tools; advancedknowledge of Excel preferred; strong mathematical background. Strongly Preferred - advanced knowledge of at least one of the following areas: risk adjustment factors, risk stratification, strong technical writing, and presentation skills;and demonstrated experience of presenting findings and interpreting analyses.

Required Licensure:

If RN, must be currently licensed as a Registered Nurse in the State of Georgia or hold a privilege to practice in the State of Georgia under the Enhanced Nurse Licensure Compact (eNLC).

Strongly Preferred Certification:

Certified Professional in Healthcare Quality (CPHQ), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC),or an AAPC Specialty Medical Coding Certification

Other Minimum Skills:

Ability to self-direct and appropriately delegate. Ability to exercise judgment, problem solve, think critically and make decisions consistent with WellStar philosophy, goals, and objectives.

Demonstrated strong leadership, communication, project management, and team building skills.

Excellent communication skills (written and oral) and the ability to present oneself and/or ideas with clarity and compassion.

Ability to create and maintain solid relationships with care providers and advocate for the voice of the patient.

Strong analytical, problem solving and decision-making skills.

Excellent organizational skills and the ability to work within all levels of the organization.
More Information on Wellstar Health System
Wellstar Health System operates in the Healthtech industry. The company is located in Marietta, GA. Wellstar Health System was founded in 1997. It has 25000 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 52 open jobs at Wellstar Health System, click here.
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