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Manager Quality Education & Coding

Company: Community Health Plan of Washington
Location: Washington
Posted on: November 19, 2023

Job Description:

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following page: Job Category: Quality & Performance Management Community Health Plan of Washington is
an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.Our commitment is to:

  • Strive to a pply an equity lens to all our work.
  • Become an anti-racist organization
  • Create an equitable work environment.About the RoleResponsible for the development of provider coding education and works with the Clinic Partnership team to support community health center (CHC) specific training and development plans for organizational improvement.To be successful in this role, you:
    • Possess a bachelor's degree in Health Administration, Health Information, or closely related field or an equivalent combination of education and highly relevant experience (required).
    • Have a valid Registered Health Information Administrator (RHIA) or Certified Professional Coder (CPC) (required).
    • A valid state Driver's License (required). This position may involve traveling on behalf of the Company. It is essential that a current driver's license and an acceptable driving record is maintained.
    • Have (3) years managing medical record review and/or coding for HEDIS, HCC or other like projects (required). -
    • Have (6) years' experience as a supervisor (preferred)
    • Possess experience and knowledge in educating providers and care teams in a health care setting.
    • Proficiency with computer business applications, and a working knowledge of electronic medical record (EMR) software.
    • Have proficiency and experience with Microsoft Office products.
    • Have prior experience in clinical, quality, coding, and billing workflows pertinent to a community health center setting required.Essential functions and Roles and Responsibilities:
      • Direct leadership, management, coaching and development of the Clinic Quality Advisors
      • Coordinates and collaborates with the Quality Concerns team to provide timely review of pending or open cases that need clinical oversight.
      • Develops CHC learning plans for risk adjustment coding education and works with CHC leadership and staff for implementation strategies and delivery targets.
      • Implements and delivers CHC-specific coding education for organizational improvement as defined by each participating CHC partner.
      • Coordinates planned work with the team and manages CHC expectations for successful consulting and education projects with participating CHCs.
      • In conjunction with the department management staff, collaborate on the continued development of the clinic partnership curriculum and menu of available education services for providers and staff.
      • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.Knowledge, Skills, and Abilities:
        • Knowledge and experience in delivering education to health care providers and staff.
        • Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs) and Chronic Illness and Disability Payment System (CDPS).
        • Advanced, applied knowledge of ICD-CM codes, coding conventions and coding guidelines.
        • Strong written, verbal and presentation skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
        • Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.As part of our hiring process, the following criteria must be met:
          • Complete and successfully pass a criminal background checkCriminal History: -includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
            • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
            • Vaccination requirement (CHPW offers a process for medical or religious exemptions)
            • Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.Compensation and Benefits:The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 69 and has a 10% annual incentive target based on company, department, and individual performance goals.CHPW offers the following benefits for Full and Part-time employees and their dependents:
              • Medical, Prescription, Dental, and Vision
              • Telehealth app
              • Flexible Spending Accounts, Health Savings Accounts
              • Basic Life AD&D, Short and Long-Term Disability
              • Voluntary Life, Critical Care, and Long-Term Care Insurance
              • 401(k) Retirement and generous employer match
              • Employee Assistance Program and Mental Fitness app
              • Financial Coaching, Identity Theft Protection
              • Time off including PTO accrual starting at 17 days per year
              • 10 standard holidays, 2 floating holidays
              • Compassion time off, jury duty Sensory/Physical/Mental Requirements:Sensory*:
                • Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.Physical*:
                  • Extended periods of sitting, computer use, talking, and possibly standingMental:Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Community Health Plan of Washington, Washington DC , Manager Quality Education & Coding, Executive , Washington, DC

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