Clinical Coding Specialist in Denver, Colorado, United States
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HealthOne

Clinical Coding Specialist

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Description

SHIFT: No Weekends
SCHEDULE: Full-time
Salary Estimate: $60569.60 - $90875.20 / year
Learn more about the benefits offered for this job.

The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Clinical Navigation Specialist - Medical Coder (CRC/CPC)
HealthONE Division
Colorado Care Partners
 
We are seeking a Clinical Navigation Specialist for our center to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!
 
We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.
 
Healthcare Corporation of America (HCA) is a community of 94,000 Registered Nurses and 38,000 active physicians. We have over 1,900 facilities ranging from hospitals, freestanding ER’s, ambulatory surgery centers, and urgent care clinics. Our facility based staff continues to raise the bar in patient care. Ten HCA hospitals have been named in IBM Watson Health’s top 100 best-performing hospitals based on patient satisfaction and operational data.
 
Colorado Care Partners (CCP) is a Colorado-based Clinically Integrated Network (CIN) and Accountable Care Organization (ACO). Our CIN/ACO network is comprised of more than 320 clinicians to include physicians and advanced practice providers, 6 acute care hospitals and 2 specialty hospitals who have come together in value based care. Our clinical team works collaboratively with our network of internists, family physicians and pediatricians to ensure every patient receives the best medicine at every point in their healthcare journey.
 
CCP’s goal is to partner with practices in the following areas:
 
Wellness and prevention
Chronic disease management
Improved patient access to care
Improved collaboration and communication amongst providers across all healthcare settings
Providers who become members of CCP are responsible for demonstrating how they provide high-quality care by adhering to value-based data and benchmarks across diverse care settings. It gives them and their practice an opportunity to create a patient-centered solution that improves patient outcomes while reducing costs.
 
Patients benefit from coordinated, evidence-based healthcare that allows them to better manage their own health in partnership with CCP providers. While providers and their practices benefit from establishing a more efficient and effective plan of care for all their patients.
 
• The Medical Center of Aurora: Magnet® designated hospital, Level II Trauma Center, 346 licensed beds
• North Suburban Medical Center: Level III Trauma Center, 157 licensed beds
• Presbyterian/St. Luke’s Medical Center & Rocky Mountain Hospital for Children: Level II Trauma Center, 680 licensed beds
• Rose Medical Center: Magnet® designated hospital, Level II Trauma, 422 licensed beds
• Sky Ridge Medical Center: Level II Trauma, 274 licensed beds
• Swedish Medical Center: Level I Trauma, 408 licensed beds
• Spalding Rehabilitation Hospital: 78 licensed beds
• Behavioral Health and Wellness Center at the Medical Center of Aurora: 120 licensed beds

 

The role of the Clinical Navigation Specialist is to support medical record documentation, coding and quality measures in the primary care practice offices participating in the HealthONE’s Clinically Integrated Network:  Colorado Care Partners (“CCP”) . To achieve high-quality outcomes in primary care the Clinical Navigation Specialist to have knowledge of HEDIS, CMS Hierarchical Condition Category (“HCC”) coding and billing guidelines, clinical standards, outcomes management skills.  In this role, practice level support as well as payer partnerships will be imperative to success.

The personnel in this position uses their knowledge of documentation guidelines, along with clinical skills and practice management knowledge to assist in any and all documentation audits and/or billing functions as determined by the CMO, Data & Analytics, and/or Quality department(s) while ensuring that all quality measures are completed annually for the patient populations for both Managed Care and Medicare. 

  • Leads all audits of documentation, coding and billing practices, in CCP primary care practices.
  • Works closely with the UnitedHealthCare Medicare Advantage Plan (UHC) on supporting special populations and focusing efforts in areas that need improvement.  Closely communicating with the UHC, the practice, and CCP leadership.
  • Performs analysis on practice risk coding based on information from UHC, and creates a stratified plan to work with practices that have most opportunity or impact on the Network
  • Works in tandem with UHC on specific documentation requirements, education materials, and training techniques. 
  • Queries providers on specificity of coding whenever there is question on specificity level
  • Creates Education Series that will train practice providers, billing, and support staff, as well as CCP staff, for Medical Risk Adjustment/HCC coding opportunities
  • Working knowledge of STARS measures for Medicare Advantage.  This role will develop the STARs program and upload quality documentation to result in gap closure for UHC MA members.
  • Assists with all Scorecard initiatives – working with the PCP offices in capturing the coding data to support the performance on Scorecard metrics
  • Maintains and database with the results of all medical chart reviews performed, with ability to report on statistics and practice progress on coding initiatives
  • Assists in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary
  • Reports any issues to supervisor, the Network CMO, and the Data and Quality Teams as necessary
  • Is the CCP staff educator and expert on Medical Risk Adjustment coding
  • Performs other duties as assigned
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!

Qualifications

EDUCATION AND EXPERIENCE:

  • High school diploma or equivalent
  • Minimum of 2 years coding experience
  • Experience with clinic billing and coding required
  • Knowledge of several EHR systems preferred; preferably Athena, eCW, and Greenway
  • The American Academy of professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification preferred; CPC will be considered with MRA experience
  • Clinical background preferred

KNOWLEDGE/SKILLS/ABILITIES:

  • Strong knowledge of CMS coding guidelines
  • Exceptional interpersonal, public speaking, and presentation skills. Clear and confident communicator internally and with members/external partners
  • Intermediate knowledge of Microsoft Office applications, including Word, Excel and PowerPoint
  • Adaptability – Maintaining effectiveness when experiencing major changes in work tasks or the work environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
  • Managing Conflict – Dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Ability to work independently; resourceful and proactive
  • Passionate about improving the healthcare system
  • Ability to travel within the Denver front range area
 
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

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Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

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