Job Summary :

The Clinical Documentation and ACO Quality (CDAQ) Consultant is responsible for improving the overall quality and completeness of clinical documentation; facilitates modifications to clinical documentation through interaction with physicians, office nursing staff, and medical records coding staff to ensure that documentation reflects complete and accurate level of service rendered to patients. Will need to proactively educate providers and other clinician members of Hendricks Regional Health in documentation best practices. The position will improve data quality, appropriately risk stratify the population and close quality gaps in care of Hendricks Regional Health by reviewing medical records prospectively with providers to determine gaps in documentation and open gaps in care. Will query the providers about any gaps to clarify the documentation to support and record appropriate ICD-10 diagnosis codes. The clinical documentation and ACO quality consultant will ensure accuracy and quality among providers, nurses, billing teams, and other healthcare staff. They will work collaboratively with Care Coordination teams to help identify and close care gaps. An understanding of risk adjustment models and hierarchical condition category (HCC) coding is necessary.

Job Description

Essential Responsibilities:

The Clinical Documentation and ACO Quality Consultant will have the following list of duties and tasks that may include, but not limited to,

1. Identify opportunities to impact risk adjustment factors through documentation of complicating and comorbid, or major complicating and comorbid conditions and formulate a provider query based on query guidelines with timely provider follow-up.
2. Complete provider clarification queries per guidelines for instances in which documentation in the medical record is ambiguous, incomplete, or conflicting, and provide timely provider follow-up as needed.
3. Facilitate communication and collaboration among coders, providers, nurses, and office staff to identify documentation opportunities that appropriately reflect patient severity of illness and risk of mortality.
4. Applies knowledge of medical terminology and medical procedures to properly evaluate clinical documents.
5. Ensure all clinical documents are following federal laws in terms of composition.
6. Works with leadership and physicians to develop and monitor key performance indicators for clinical documentation and quality performance.
7. Recommend strategies for improving record-keeping processes, attend meetings to present current clinical documentation trends, findings, and provide education on the impact of clinical documentation.
8. Prepares reports for internal monitoring, compiles data for reporting, and discusses reports with leadership
9. Takes continuing education courses and stays up to date on changes in laws governing clinical documentation and population health quality metrics.
10. Perform other duties as assigned.
11. Certification in clinical documentation improvement within 2 years of employment preferred.

Qualifications:

• Two (2) years of clinical coding experience. (Physician practice environment preferred)
• or Two (2) years clinical quality reporting experience (ACO or HEDIS preferred) with at least one of two types of credentials:

- HIMS professional candidates must have experience in ICD-10 CM coding.

• Coding credential from either AHIMA or AAPC preferred. 

- Clinical Candidates must be credentialed and hold a current nursing license as an LPN, or RN (ICD-10 experience is a plus).

• Excellent oral and written communication skills.
• Be organized; able to set priorities and meet deadlines.
• Proficient computer skills Word and Excel
• Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly. 

Additional knowledge or experience of the following preferred but not required:

• Knowledge of pertinent Federal, State, and local laws, codes, and regulations regarding documentation and quality requirements.
• Experience using EPIC
• Working knowledge of HEDIS quality care measures, population health or Accountable Care Organization.
• Documentation improvement certification from either AHIMA or AAPC. (C-CDS or CDEO)
• CPHQ certification

Work Shift :

1st Shift (United States of America)

Scheduled Weekly Hours :

40