What are the responsibilities and job description for the ACO Clinical Documentation Lead position at Louisiana Health Service & Indemnity Company?
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The ACO Clinical Documentation Lead is responsible for assessing and improving processes of the participating practices to ensure accurate and complete clinical documentation. Documentation will include diagnosis codes, services/procedures completed, clinical measurements, etc. Such documentation is fundamental to evidence-based medicine, appropriate payment under pay-for-performance contracts and quality programs. This lead position is also responsible for education and support of clinical and office staffs of participating practices on Clinical Documentation Integrity best practices.
- This role does not manage people
- This job reports to: Departmental Leadership
- Necessary Contacts: This position must be in contact with all levels of BCBSLA leadership along with external contacts.
Education
- Bachelor's degree in a related field is required.
- MS in Nursing, APRN or Information Management Professional (MIM) preferred
- 7 years of healthcare industry experience required
- 3 years of experience supporting healthcare value-based programs required; Medicare Risk program experience preferred. Experience may run concurrently.
- Must have the ability to travel up to 30% to participating practice offices.
- Advanced knowledge of clinical standards of care, preventive health standards and clinical documentation and diagnostic coding.
- Advanced knowledge of ICD-10 Guidelines
- Excellent presentation, interpersonal and oral and written communication skills are required.
- Microsoft Office Software proficiency is required: ability to perform advanced level functions in Excel, Word, PowerPoint, Outlook, etc.
- Requires critical thinking, problem solving and problem resolution skills.
- Must be able to manage multiple priorities and meet deadlines.
- Requires the ability to work independently, on a lean startup team and with internal and external staff at all levels (e.g. management, technical, administrative and support staff, physicians, etc.
- Certified Coder (AAPC), CPC, CRC, CCS-P, CCS-H, RHIT certifications preferred
- Develops standard processes, job aides and common error prevention tools to support clinical documentation integrity. Engages with practice management team members to incorporate best practice processes into daily workflow including optimizing use of EMR.
- Facilitates education and/or educates providers and office staff on best practice clinical documentation procedures to ensure accurate and complete clinical documentation.
- Prepares analyses, reports, retrospective reviews to monitor and improve accuracy and completeness.
- Provides guidance and consultation to internal practice staff on coding proficiency.
- Collaborates with population health leads to identify gaps in clinical documentation to support quality programs.
- Supports participating practices to standardize work processes for the collection and abstraction of reportable Quality data.
- Directs retrospective reviews and analyzes data to identify trends and improvement opportunities.
- Advises practice staff as to means to comply with all applicable Federal, State, and/or Parish/County laws and regulations related to Medicare coding and documentation guidelines.
- Participates in all population health management activities.
- Collaborates with practice staff to achieve objectives.
- Performs other duties or responsibilities as assigned by leadership.
- Up to 30% of work time may be conducted at participating practices.
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
- Perform other job-related duties as assigned, within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
