Doc and Coding Proj Coord

The Documentation & Coding Project Coordinator is responsible for managing and monitoring the activities of the Clinical Documentation and Coding Department, in which they audit provider documentation and educate on coding practices along with other related projects that support Healthfirst’s quality objectives.

• Responsible for expanding and improving medical records acquisition for RADV risk adjustment program
• Manages relationships and effectively communicate with internal and external partners regarding quality objectives and targets as they relate to CMS audits.
• Collaborates with key departments on Quality driven initiatives championing process improvement
• Analyzes data to identify data-driven opportunities for improvement and determine root causes in areas that need improvement to be successful in our CMS audits.
• Ensures a working relationship on internal group projects for process improvements.
• Analyzes data to identify trends, issues, and opportunities for performance improvement as it relates to clinical quality
• Prepares quality improvement related presentations that accurately summarize complex information, details and data
• Assists other departments with clinical documentation and coding initiatives
• Provides reporting and summaries on CMS audits in areas, but not limited to, noticeable trends, medical records, and issues.
• Ensures accuracy and completeness of medical records and complying with HIPAA guidelines.
• Analyzes invoice data to reduce billing errors and ensure billable info is correct for the Clinical Documentation and Coding Department audits.
• Additional duties as necessary and as directed

• HS Diploma or GED from an accredited institution
• 2-3 years in medical record retrieval in a health plan/ provider setting or administrative experience in lieu of health care setting
• Strong writing, time management, critical/creative thinking, communication, and problem-solving skills.
• Strong working knowledge of Microsoft Office Suite and Outlook

• Associates degree or higher from an accredited institution
• Prior experience in Managed Care/Health Insurance, in a health-related field or environment
• Background in health care or managed care. This can include work experience and/or education.
• Experience with a health plan's quality improvement/management department
• Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc.).
• Understanding of CMS RADV requirements and medical record documentation best practices

Ensures all work is compliant with relevant regulatory guidelines.

N/A

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