Accurate Clinical Documentation Provider Educator

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Accurate Clinical Documentation Provider Educator

Accurate Clinical Documentation Provider Educator
TN

The Accurate Clinical Documentation Provider Educator partners with Wellvana affiliated practices and health systems on all aspects of risk adjustment coding, regulatory requirements, and proper documentation procedures for attributed patients in Medicare Advantage, MSSP, and ACO LEAD programs.

The Accurate Clinical Documentation Provider Educator is responsible for reviewing clinical data and patient documentation to validate and support accurate diagnosis capture in advance of in-office physician visits. This role focuses on delivering personalized feedback to individual providers and practices, identifying coding trends and documentation patterns through audits and data analysis, and driving continuous improvement in documentation quality.

The Accurate Clinical Documentation Provider Educator effectively communicates and implements coding education initiatives, partnering with providers to ensure understanding and compliance. This role also supports change management efforts to promote successful adoption of documentation and coding best practices across the organization.

The Accurate Clinical Documentation Provider Educator must have a thorough understanding of the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy and be able to communicate this knowledge effectively to physicians and their practice leaders. Maintaining a comprehensive schedule and visit log is crucial as is the documentation, and storage, of all materials utilized in practice and health system discussions.

The Accurate Clinical Documentation Provider Educator is responsible for building positive relationships with assigned Physicians and serves as a key point of contact for any questions or concerns that may arise.

• Industry Knowledge
• Thorough understanding of the industry rules and regulations and particularly the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy, open condition reporting, identifying unreported conditions, readdressing open chronic conditions
• Demonstrated ability to communicate this knowledge effectively to physicians and their practice leaders.
• Expertise in Prospective, Retrospective, and Concurrent review processes
• Organization and Initiative
• Effectively coordinate and schedule visits with practices, prepare and distribute practice specific materials timely (e.g., minimum of 48 business hours in advance), conduct education sessions, document follow-ups, and store corresponding materials in central repository
• Identify any error trends in provider clinical documentation and coding by analyzing data derived from coding reviews and internal audits results.
• Construct training materials utilizing internal standards and insights from respective practice data sets and reviews. Consult with providers and billing staff to correct errors found.
• Escalates issues to leadership when a partner is unresponsive to meeting requests or follow-up communications, or when there is a lack of adherence to clinical documentation and risk adjustment guidelines.
• Attention to detail to maintain a practice schedule, visit and travel log to document and track all practice outreach, engagement and to organize and file specific materials utilized in education sessions
• Distribute company provided educational materials and coding tools to guide providers to utilize Wellvana technology and solutions to manage their clinical documentation activities.
• Complete practice, or function, special projects as assigned by leadership
• Practice Relationship Management
• Build and maintain professional relationships with providers and their staff within assigned region, performing monthly in person, or virtual, visits to assigned offices depending on practice size, location and practice’s demonstrated understanding of clinical documentation guidelines.
• Ability to collaborate with practices to review patient medical records on a timely basis in advance of upcoming patient visits.
• Monitor Prospective and Concurrent workflow adoption and identify and…