Meaningful Careers.

Your Role

As a Quality Documentation Reviewer Supervisor, you will partner with physician offices, vendors and Advanced Practice Practitioners within our established partnerships to assess the health information that includes improving clinical documentation, quality measures, and regulatory guidelines. The Quality Documentation Reviewer Supervisor will work in collaboration with the Medical Coders, as appropriate. You serve as a subject matter expert in clinical documentation, quality measures, and regulatory guidelines.

Primary Functions of the Supervisor, Quality Documentation Review Include:

• Perform concurrent and retrospective second-level reviews on specific types of opportunities.
• Conduct regular reviews of pre-visit planning documents and provide coaching and feedback to providers to improve clinical documentation.
• Work collaboratively with physicians, Advanced Practice Nurse Practitioners, other healthcare professionals, and coding staff to ensure that clinical information in the medical record is present and accurate to track clinical severity.
• Audit clinical documentation and coded data to validate documentation supports diagnoses and treatment as well as identifies deficiencies of evidence-based practices.
• Research, analyze, recommend, and facilitates plan of action to correct discrepancies and prevent future documentation discrepancies.
• Assist management with training new Quality Documentation Reviewers (QDRs) to include daily monitoring, mentoring, feedback, and education.
• Track technology issues with process tools and coordinate with leadership on updates.
• Lead weekly huddles or meetings for Coding Documentation Improvement (CDI) and QDR teams.
• Serve as the main point of contact for external and internal QDR feedback requests.
• Work closely with external CDI consultants to determine any educational opportunities identified via external reporting or chart reviews.
• Supervise, ensure competency, and evaluate the activities of assigned staff.
• Report and analyze the data for the QDR program.
• Actively demonstrate the organization’s mission and core values and conducts oneself at all times in a manner consistent with these values.
• Understand and adhere to all laws and regulations pertaining to patient health, safety, and medical information.
• Perform other related responsibilities as assigned.

How You Qualify

You reviewed the Who You Are section of this job posting and immediately felt the need to read on. This makes you a match for our innovative culture. You accept things change quickly in a startup environment and are willing to pivot quickly on priorities.

• Must have reliable access to high-speed internet to ensure seamless remote work communication and productivity
• Associate degree in nursing required; Bachelor’s degree or higher in nursing preferred
• Current Registered Nurse License is required, plus any coding certification from either AHIMA or AAPC
• CMS HCC Risk Adjustment expertise
• 3+ years of chart auditing experience
• 3+ years of clinical practice in a hospital, home care, or nursing home setting
• Clinical Documentation certification either from AAPC or AHIMA preferred
• Outpatient coding credential from AAPC or AHIMA preferred
• Demonstrated experience in reviewing clinical documentation charts for audit
• Demonstrates understanding of current risk adjustment guidelines including Value-Based Care initiatives and quality metrics
• Demonstrates knowledge of pathophysiology, disease management, and coding guidelines.
• Working knowledge of HIPAA Privacy and Health Information Security Rules.
• Experience with EMR systems such as EPIC, Athena, Medent, Allscripts
• Demonstrated proficiency in computer skills, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, internet browsers, and Microsoft Teams
• Strong people skills and ability to build collaborative relationships with providers.
• Outstanding organizational skills and an ability to operate efficiently and independently.
• A sound knowledge of medical coding guidelines and regulations, including compliance and reimbursement. This allows for a clear understanding of the impact of coding on payment models.
• A thorough understanding of anatomy, pathophysiology, and medical terminology necessary to correctly code using 10 CM coding guidelines