Clinical Condition Documentation Specialist

POSITION DESCRIPTION:

The Clinical Condition Documentation Specialist plays a critical role in providing documentation and coding support and education across all specialties. This role involves collaborating with healthcare providers, coders, and payers to review, analyze, and improve medical documentation and coding, ensuring compliance with risk adjustment coding standards and guidelines. The CCD Specialist is instrumental in managing payer specific programs to optimize success in APMs.

ESSENTIAL JOB FUNCTIONS:

1. Responsible for reviewing the HCC Pre-visit Documentation in TogetherCare and providing recommendations to the providers in the HCC Our Practice Advisories (OPA) in alignment with risk adjustment coding standards and guidelines.
2. Responsible for reviewing patient’s electronic charts to identify potential CMS-HCC chronic conditions and adding them to the HCC OPAs for provider review.
3. Identify inaccurate or missing diagnosis codes on patient’s problem list and correct as appropriate.
4. Responsible for providing mentorship and ongoing support to assigned CRC new hires.
5. Provide assistance and expertise in addressing complex coding inquires.
6. Supports Associate Director in developing and implementing the Clinical Condition Documentation Program strategy for achieving success in APMs. Assists AD with leading Risk Score Strategy monthly meeting to review program structure, progress against strategic goals and key performance metrics, and outstanding issues.
7. Develops educational materials to ensure providers have the knowledge and resources to validate all chronic conditions during each patient's visit.
8. Escalates identified system-level documentation and coding issues to the Associate Director – Clinical Condition Documentation for determination of corrective actions at both the system and local levels.
9. Communicates thoroughly and promptly with the Associate Director – Clinical Condition Documentation for potential issues and makes recommendations pertaining to new and ongoing projects.
10. Leading, managing, and organizing multifaceted projects associated with clinical condition documentation.
11. Supports IHA’s participation in Clinical Condition Documentation programs, including performance monitoring and required reporting.
12. Reviews provider documentation to ensure HCC codes are accurate, coded to the highest level of specificity, and meet current documentation guidelines to identify areas of opportunities.
13. Manages multiple practices and assignments simultaneously.
14. Coordinates with subject matter experts internal and external to IHA.
15. Creates Standard Work Instructions and Job Aids to support CCD processes and workflow.
16. Effectively manages meetings, agendas, outcomes, follow-ups and minutes process.
17. Proactively identifies and raises issues; makes recommendations.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
2. Must be able to work effectively as a member of the Population Health team.
3. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
4. Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
5. Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
6. Maintains general knowledge of Trinity Health Medical Group  office services and in the use of all relevant office equipment, computer and manual systems.
7. Maintains strict confidentiality in compliance with Trinity Health Medical Group  and HIPAA guidelines.
8. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respects cultural differences.
9. Uses resources efficiently.
10. If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: Associates Degree in business or health care preferred, or an equivalent combination of education and experience.

CREDENTIALS/LICENSURE: One of the following certifications required: AAPC (CRC), AAPC (CPC), RHIT.  Secondary specialty certification(s) preferred.

MINIMUM EXPERIENCE: 2-4 years’ experience in risk adjustment coding preferred.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Knowledge of industry-appropriate terms generally used in clinical condition documentation.
2. Maintains complete knowledge with all diagnosis coding guidelines.
3. Proficient at data analysis.
4. Ability to support projects with general direction with a moderate degree of ambiguity.
5. Ability to support multiple projects simultaneously.
6. Excellent communication skills in both written and verbal forms, including proper phone etiquette.  Ability to write understandable and unambiguous projects.
7. Ability to facilitate a group discussion and effectively manage meetings. Ability to speak before groups of people, either in-person or virtually.  
8. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and health care industry changes.
9. Demonstrated ability to exercise sound judgement, trouble-shooting and problem-solving skills, i.e., identifying complex problems, reviewing options and making appropriate recommendations based on the business case presented.
10. High-level of proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records/templates (e.g., Epic), Microsoft Office (Excel, Access, Outlook, Word, PowerPoint), email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job. Ability to work with new applications, including vendor software, understanding of terminology and processes utilized to enhance and maintain reporting.
11. Ability to work independently and collaboratively in a team-oriented environment as a member of the Population Health team. Possesses courteous and friendly demeanor.
12. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff and management, senior management group, site medical directors, division heads, providers, patients, family members, outside customers, vendors, hospitals and community groups.
13. Ability to cross-train in other areas of practice/department in order to achieve smooth flow of all operations.
14. Ability to perform mathematical calculations needed during the course of performing basic job duties.
15. Knowledge of the compliance aspects of clinical care, patient privacy and best practices in medical office operations.
16. Willing to gain an overall understanding of IHA structure and work flow processes throughout the organization and ability to provide analytic support for the company structure.
17. Ability to handle patient and organizational information in a confidential manner.
18. Ability to drive to other office/practice sites and meeting and training locations.
19. Successful completion of IHA competency-based program within introductory and training period. 

MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, phone work and charting.
2. Physical activity that often requires time working on a computer.
3. Physical activity that occasionally requires lifting up to 20 lbs.
4. Physical activity that occasionally requires walking, bending, stooping, reaching, climbing, kneeling and/or twisting.       
5. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus. 
6. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in both an office environment and in a medical facility. It involves frequent interruption, competing priorities and significant interaction with people which can be stressful at times and result in competing priorities. Employees may be working where there is patient care equipment. Hazardous materials, including bloodborne pathogens and bodily fluids are also present.