Working Each Day to Make a Difference

At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.

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Quality, Education & Coding Specialist -- Hybrid, WA

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[POSITION PURPOSE:]{.underline}

Quality, Education & Coding Specialist works collaboratively with clinic and providers for enhancements, training and education for risk adjustment documentation and performs medical record reviews in accordance with HEDIS technical specifications. This position requires demonstrated knowledge, skill, and ability to educate, train and advise clinical staff for process improvements.

This position is also responsible for performing quality medical record reviews, assisting providers and staff in the improvement of clinical documentation and workflows, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records.* *

[PRINCIPAL DUTIES:]{.underline}

Collaborate, educate, and train clinical support staff and providers on risk adjustment documentation and workflows specific to HCC and CDPS models.

Ensure compliance with internal coding guidelines, department policies, and CMS risk adjustment coding guidelines, rules, and regulations. Keep current on regulatory and coding issues/best practices including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.

Audit provider and vendor documentation of ICD-10 codes to ensure adherence with risk adjustment guidelines.

Perform root cause analysis to identify issues that may contribute to coding, documentation, claims or other revenue cycle deficiencies.

Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards to providers and staff.

Provide real-time support for clinical care and HEDIS/Star teams for annual submission.

Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and history.

Maintaining productivity level of a minimum of 50 chases/charts per defined period according to policy.

Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.

Other duties as ass