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KPCA Clinically Integrated Network Quality Assistant Director, Quality Coding

Posted: 07/27/2022

JOB DESCRIPTION
 
Job Title:
KPCA Clinically Integrated Network
Quality Assistant Director, Quality Coding
Control No. #
Department: CIN-Quality Reports To: Clinical Director, CIN - Quality Improvement
Grade: FLSA Status: INSERT EXEMPT OR NON-EXEMPT
SUMMARY
The Kentucky Primary Care Association (KPCA) Clinically Integrated Network (CIN) Quality Assistant Director for Quality Coding should be an experienced clinical quality coding leader who builds trust and confidence among participating practices to drive value-based care performance within the CIN’s Value Based Care initiatives in collaboration with a team of other CIN Directors.  The Assistant Director for Quality Coding is responsible for leading the development of model and best-practice Value-Based Care Quality Coding activities and programs intended to promote the improvement of the documentation and coding for quality performance.  The Assistant Director should have extensive value-based quality documentation and coding program management and developing including auditing, compliance, and professional clinical staff and provider feedback and training.   
 
The Assistant Director will maintain knowledge of current and emerging compliant quality documentation and coding strategies, best practices, and related trends in value-based care within the Federally Qualified Health Center (FQHC) and Rural Health Clinics (RHC) healthcare setting.  The role leads in the analysis, planning and strategic implementation of KPCA’s CIN Value-Based Care quality documentation and coding support services for success in primary care Value-Based Care, including, but not limited to:
•                Documentation & Coding audits, compliance, and reimbursement for physician practices including up-to-date CPT, HCPCS, & ICD-10
•                Implementation of current AMA, OIG, CMS and other national coding and compliance guidelines
•                Current and upcoming NCQA HEDIS Quality Measures & Technical Specifications                                   
•                FQHC & RHC Coding & Billing Compliance Standards
Analysis & Report of Payer Claims, Electronic Medical Records, and Billing Systems
 
The ideal candidate will have development experience, a vision for growing KPCA CIN services for participating practices, and a commitment to KPCA’s mission of promoting high-value care.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The following is a summary of the major functions of the KPCA CIN-Quality Assistant Director for Quality Coding with, and among, CIN member practices and the KPCA CIN Team. He/she may perform other duties, both major and minor, which are not mentioned below (specific functions and assignments related to CIN Quality Coding activities may change as the support program develops):
  • Builds strong relationships with and is accessible to clinical and operations leaders at participating practices.
  • Analyzes CIN quality documentation and coding related data, ensure its accuracy, and develops reports to guide network- and practice-level improvement within quality, cost, and utilization
  • Provides feedback written and verbally to coders, auditors, and/or providers.
  • Audits medical records and claims and prepares audit summary findings, providing detailed comments related to the audit findings and make recommendations to improve quality capture.
  • Prepare oral and/or written reports of project activity for Supervisor and/or practice leads
  • Creates innovative solutions and process enhancements to drive financial and quality success.
  • Creates programs/pilots to improve engagement with strategic partners.
  • Works collaboratively with KPCA CIN leadership and CIN Staff Team Members to participate in strategic planning, program implementation, and oversight of initiatives in alignment with KPCA CIN objectives.
  • Continuously evaluates process, identify problems, and propose process improvement strategies to enhance delivery of quality documentation and coding initiatives.
  • Maintains Certified Professional Coder (CPC) certification status without lapse
  • Utilizes and maintains the most up to date /latest accepted coding guidelines
  • Abides by department guidelines, company policies, and HIPAA regulation
  • Performs other duties as assigned.
This job description may not include all of the employee’s duties and responsibilities, the scope of which remains at all times subject to the management and direction of the employee's supervisor.
SUPERVISORY RESPONSIBILITIES
·       This position is planned for future team member supervisory responsibilities as the program develops.
QUALIFICATIONS, EDUCATION & EXPERIENCE
KNOWLEDGE, SKILLS, AND ABILITIES
  • Extensive healthcare industry knowledge and experience around all aspects of coding.
  • Extensive healthcare industry knowledge and experience in auditing, compliance, and reimbursement for physician practices including CPT, HCPCS, & ICD-10
  • Extensive knowledge of AMA, OIG, CMS and other national coding and compliance guidelines.
  • Experience developing and delivering training material, PowerPoint presentations, webinars and reports for physicians, management, and coders.
  • Demonstrated ability to successfully manage multiple projects simultaneously.
  • Strong leadership and relationship-building skills.
  • Experience as a primary care practice leader in program, protocol, and procedure development
  • Change Management Skills
  • Detail oriented with the ability to manage multiple projects and priorities.
  • Working knowledge of primary care operating systems, software and programming including electronic medical records (EMR), patient management and billing systems.
  • Great customer service and interpersonal skills.
  • Experience as a coding leader within the community health centers/Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) setting.
MINIMUM QUALIFICATIONS
  • Certified Professional Coder certification plus ten (10) years of experience working in primary care value-based care quality documentation and coding practice
  • Ten (10) years’ experience within healthcare program development and implementation
  • Experience working in or familiarity with primary care practice workflows, processes, and procedures
  • Knowledge and experience around all aspects of healthcare coding, including value-based care quality coding.
  • Knowledge and experience in auditing, compliance, and reimbursement for physician practices including CPT, HCPCS, & ICD-10
  • Knowledge of AMA, OIG, CMS and other national coding and compliance guidelines.
  • Extensive Knowledge of NCQA HEDIS Quality Measures and coding for quality credit
  • Excellent verbal and written communication skills, effective interpersonal and leadership skills, ability to analyze clinical data, ability to prepare and present written reports, presentations, meeting facilitation and reports.
  • Experience in training and facilitating with and among care team members within the primary care practice setting
  • Works effectively with others and can organize workload, as well as assume responsibility and maintain confidentiality.
  • Must be able to work independently, exercise appropriate decision-making skills, and function effectively on a team.
  • Proficient in the use of Microsoft Office (Word, Excel, Outlook, PowerPoint).
  • Experience working with primary care safety net programs preferred.
  • Knowledge of value-based care and contracts preferred.
REASONING ABILITY
·       Analyzes information/facts and draws conclusions, judgments, or inferences
·       Evaluates situations and communicates with others on “next steps”
·       Critical analysis and problem solving
·       Interprets a variety of instructions furnished in written, oral, diagram, or schedule form 
·       Self- Starter
PHYSICAL/MENTAL DEMANDS
This position regularly requires the employee to:
·       Demonstrate clear verbal and written communication and comprehension
·       Sit at a desk, view a computer screen, write, stand, walk, and lift or move objects generally up to [10] pounds (may require sustained period in a sitting position and regular typing on a computer keyboard)
·       Analyze, think, and decide (requires focus, attention, and concentration- detail oriented)
 
This position occasionally requires the employee to:
·       Travel more than one hour in a car
 
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. If possible, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 
 
WORK ENVIRONMENT
 
Office
Home-based office primarily; some travel to the KPCA Frankfort Office; Personal Vehicle Required for Business Travel with Reimbursement Per Mile based upon current IRS Standard Mileage Rates. High speed internet required
 
The work environment described here is representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be available to enable individuals with disabilities to perform such essential functions. The availability of any reasonable accommodation will be determined by the Company in consultation with the individual on a case-by-case basis in accordance with Company policy.

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