Quality Nurse & Coding Manager-CDI, CPC

Jacksonville, FL / Tallahassee, FL
Provider Networks – Provider Networks & ACO Support /
Full Time /
We are searching for a Quality Nurse & Coding Manager, CDI (titled internally - Quality Assurance Manager, CDI) to join the team. This QA Manager will support documentation improvement and coding compliance within practices participating in value-based contracts. This position is critical to our practices’ ability to provide better care to Medicare beneficiaries and the QA manager is expected to be an exemplar of regulatory compliance. The  QA manager will lead quality assurance program development and CDI/coding QA initiatives.  There will be opportunity to travel periodically to practices as well as engage in remote work. 

Primary Duties:

    • Quality program development in partnership with key stakeholders to lead clinical documentation and coding quality assurance initiatives.
    • Manager of coding quality program including risk assessment and mitigation strategies.
    • Ensure compliance with third party, state and federal regulations.  Reviews and provides feedback on educational collateral to ensure compliance with regulatory coding guidance.  
    • Delivers progress reports to leadership regarding CD and coding quality program initiatives. 
    • Manage auditing team conducting CDI audit work in compliance with professional standards. Create and manage the query process.

Required Qualifications:

    • Experienced in creating and running a coding quality assurance program/s for a healthcare organization for a least 1 or more in the following: ambulatory, primary care, outpatient, CHC, FQHC, or similar
    • Active nursing credential as Registered Nurse (RN) or Licensed Practical Nurse (LPN)
    • Current coding certification as a Certified Professional Coder (CPC)
    • Current documentation improvement certification as Certified Documentation Expert Outpatient (CDEO®) from AAPC or Certified Clinical Documentation Specialist-Outpatient (CCDS-O) from ACDIS/AHIMA.
    • Bachelor’s degree in a healthcare related field or equivalent work experience
    • 7+ years of recent, relevant work experience in risk adjustment CDI, coding/billing including broad based understanding of entire coding/billing and CDI processes.
    • 2+ years of Quality Assurance or coding compliance
    • 5+ year acute clinical experience
    • 2+ years of manager experience

Preferred Experience, Skills, and Abilities:

    • Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts
    • Must be detail-oriented, service-minded, possess strong verbal and written communication skills, and be fluent in (or willing and able to master) Google Suite tools.
    • Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models
    • Ability to identify and communicate opportunities to improve documentation and diagnosis capture for accurate risk adjustment coding
    • Experience working directly with physician practices and individual providers to achieve demonstrable improvement in increasing the accuracy and completeness of documentation and diagnosis coding
    • Experience with Microsoft and google 
    • Previous experience in  health plan or hospital quality assurance.

Physical Requirements:

    • Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.

In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & Clinical Employee Reimbursement Program
401(K) with up to 4% match
Stock options
And much more!

At Aledade, we don’t just accept differences, we celebrate them!   We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

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