Job Title: Quality Improvement Coordinator
Location: Jackson, TN, 38301
General Statement of Duties
This position works directly with providers, in office, to identify coding, documentation, and specificity opportunities and to deliver ongoing, targeted provider education that improves documentation accuracy, coding specificity, and reimbursement. The Quality Improvement Coordinator rounds regularly with providers, reviews charts and coding/documentation/charge trend data to determine where education is needed, and coordinates with the clinic''s third-party billing office to obtain and tailor provider-facing educational material. This position also assembles and analyzes data for outcomes measurement and quality performance measures, identifies areas of improvement, and reports findings to the Director of Population Health and Business Office Manager.
To promote, support and actively participate in providing a high level of customer service demonstrated by following the 4 key principles to excellent customer satisfaction:
- Exceptional Customer Service - Make serving patients your number one priority. Understand what patients want and exceed their expectation to the best of your ability. Patients are not interruptions to your day, they are your job.
- Display a caring, positive attitude - Smile and treat patients with respect. Remember you are the face of The Jackson Clinic; you're on stage, play the part.
- Develop consistency - Delivering a high level of customer service day after day develops trust and loyalty.
- Be a team player - A team can "fly" much better together than alone. Do everything you can to promote the team and make everybody look good.
Supervision Received
Reports directly to the assigned supervisor.
Supervision Exercised
May assist with training of new employees and development of new processes within the department.
Typical Physical Demands
- Manual dexterity for the use of a keyboard, calculator, photocopier, printer, fax, phone, and coding books.
- Requires regular movement throughout clinic and provider work areas to round with and provide education to providers, as well as sitting at a computer for extended periods for data review, trend reporting, and repetitive data entry.
- Requires minimal stooping, bending, stretching from a seated position.
- Requires corrected vision and hearing to normal range.
Typical Working Conditions
Work is performed in a medical office and clinic environment, including time spent rounding with providers in clinical work areas and time spent at a computer reviewing charts, charges, and coding/documentation data. Frequent contact with providers, employees, and other department personnel is required.
Examples of Duties
- Rounds regularly with providers, in office, to review documentation and identify coding, specificity, and reimbursement opportunities in real time.
- Provides direct, one-on-one and small-group education to providers on documentation requirements, coding guidelines, and specificity to support accurate, compliant, and well-reimbursed billing.
- Coordinates with the clinic's third-party billing office to obtain available provider education material, and tailors that material to the needs of individual providers or specialties before delivering it.
- Monitors and reports on documentation deficiencies, missing or late charges, and provider or specialty trends in order to determine what education is needed and where it should be targeted.
- Performs routine documentation and charge reviews; reviews encounters against established documentation requirements and identifies encounters requiring additional review or provider follow-up.
- Audits and analyzes patient care data from medical records following criteria established by Medicare, coding guidelines, and assists with the 360 review process.
- Reports findings to the 360 review team and keeps the Business Office Manager apprised of matters regarding coding, documentation, and provider education.
- Organizes, analyzes, and presents data from audits, provider rounding, and other sources to identify recurring trends and education opportunities.
- Tracks identified documentation and coding issues through resolution, and escalates complex or high-risk matters to the Business Office Manager or Director of Population Health for policy interpretation.
- Serves as a point of contact for provider questions related to coding, documentation, and charge capture, gathering relevant encounter, claim, and billing history before escalating issues that require policy interpretation or a decision.
- Assists in training and cross-training of new employees on coding and documentation standards.
- All coding specialists, including the Quality Improvement Coordinator, become experts within their specialties and are often asked to do research and assist the research specialist in research duties.
Knowledge, Skills and Abilities
- Ability to analyze medical record, coding, and charge trend data in an accurate and timely manner to identify provider education needs.
- Strong interpersonal and presentation skills; ability to build rapport with providers and deliver clear, constructive education in a clinical, in-office setting.
- Knowledge of coding guidelines and documentation requirements; familiarity with clinical documentation improvement (CDI) concepts is a plus.
- Knowledge of medical terminology.
- Knowledge of computer programs, spreadsheets, & Microsoft Office for data analysis.
- Skill in establishing and maintaining effective communication with providers and administration.
- Ability to work collaboratively with external partners, such as the clinic's third-party billing office, to obtain and adapt educational resources.
- Skill in organization.
- Ability to meet departmental deadlines set by management.
- Effective communication skills.
Education
- High school diploma or GED
- Associate''s or Bachelor''s degree in health information management, health administration, or related field preferred
Experience
- Two (2) years of billing, coding, charge entry, or clinical documentation improvement experience in a medical practice is required, preferably in an outpatient setting.
- Multispecialty coding experience, experience with the clinic, and experience delivering provider-facing education are a plus.
Certificate/License
- Coding Certification (e.g., CPC)
- Clinical Documentation Improvement (CDIP/CCDS) may be considered in lieu of CPC if accompanied by two (2) or more years of outpatient/professional fee coding experience.
Alternative to Minimum Qualifications
None