Clinical Quality Coder

Description

At SCP Health, what you do mattersAs part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

• Flexible schedules and work-from-home opportunities
• Strong track record of providing excellent work/life balance
• Comprehensive benefits package and competitive compensation
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

What you'll be doing:
The Clinical Quality Coder position plays a critical role in improving the quality of patient care through quality data extraction, analysis, reporting and provider education on PQRS/Core measures as well as other quality/risk documentation. The analyst will work through quality initiatives with clinical reviews on designated charts to validate documentation and services performed.

• Abstracts, analyzes, and communicates clinical data sets according to defined quality standards established by CMS, HEDIS, TJC (The Joint Commission), or other designated quality entities for variation, trending, and provider education. Reviews and identifies quality indictors in SCP emergency/ hospital medicine service lines as well as other integrated service lines via provider documentation and other data feeds. Major metrics are highlighted below:
  • Core Measure extraction
  • Merit Based Incentives (MIPS), MVP
  • Quality indicators as identified by SCP Office of Medical Affairs (OMA) or designated OMA committees
  • Risk management extraction as developed
  • Special audits as needed for quality initiatives/research
• Utilizes the Quality Query system or provider's electronic medical record systems to query providers on "missed" documentation on quality initiatives. Works with providers to obtain the adequate information and educates provider on non-compliant documentation.
• Maintains and updates knowledge regarding national quality and clinical documentation standards. Has the ability to read and apply CMS/TJC/HEDIS specification manuals. Able to assist medical directors, providers, and operation team members with CMS/TJC standards that directly apply to quality initiatives.
• Proficient at systems that monitor and maintain clinical and financial data sets to include data capture, extraction, and reporting. Proficient at utilizing SCP designated chart storage/billing systems to identify audit samples and data set abstraction. This requires the attachment of appropriate quality codes (CPT 2 codes or stat codes) for trending/ reporting.
• Able to communicate clinical/critical care/quality code selection and trending to providers and operating teams. Assists medical directors, providers, and operating teams with variances. Able to provide educational material and assistance to providers and operators to correct variances.
• Analysis of clinical services in correlation to ICD - 10 and CPT code selection. Using outcomes data, assist with quality improvement plans, systems, deep dives, and monitoring to improve SG clinical outcomes and assist physicians/facilities to meet national benchmarks.
• Performs trending analysis on quality data as well as specific data sets to assist providers and operations in improvement of quality metrics. (Emergency and Hospital Medicine Facility dashboard/provider compare and other resources on quality data)
• Works with Revenue Cycle/Operations /Information Technology SCP employees to improve chart integrity for quality extraction.
• Works with the coding department to improve data quality and coding on MIPS and other key quality, operational or patient flow metrics.
• When noted, the clinical auditor will correct quality errors and stat code errors in the system to improve data integrity in facility dashboards and provider scorecards.
• Assists with validation of key metrics for value-based compliance and reporting.

Who/What we are looking for:

• You are a certified or licensed clinician or BS/BA
• You have a current and active Registered Nurse, BSN or RHIA
• You have three years of clinical audit, core measure/MIPS, risk management or case management experience preferred
• You have five years of healthcare coding or hospital experience preferred
• You have direct experience with extraction of clinical data extraction from charts
• You are tech savvy with direct and significant skills in Microsoft Office to include Excel, Outlook Word, PowerPoint
• You have direct experience with Electronic Medical Records
• You have experience with athenaIDX/Centricity, OnBase and/or Cisco WebEX - that's plus!
• You are able to demonstrate proficiency with principles and techniques of auditing
• You have the ability to effectively present information in one-on-one and small group situations for other employees and to education both individual providers and provider groups using webinar technology
• You have the ability to travel up to approximately 15% nationally by car or commercial airline with overnight hotel stays based on business need

SCP Health and its affiliated companies require all applicants for a non-clinical position to be vaccinated against COVID-19 as a condition of employment, except where prohibited by state or local law. To demonstrate compliance with SCP Health's vaccination policy, proof of COVID-19 vaccination status will be requested upon a conditional offer of employment. SCP Health will consider religious and/or medical/disability accommodation and other legally required exemption requests as required by applicable law.

To learn more about SCP Health, please visit:
www.scp-health.com

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SCP Health is an Equal Opportunity Employer.

INDJV