Overview The RN Quality Ambulatory Care Coordinator is responsible for supporting the quality initiatives of the clinically integrated network. These functions include: Auditing medical records for qualifying documents that meet requirements to close gaps in care. Accessing multiple care management and payor applications to capture and submit documentation and claims information related to patient visits and services. This role works closely with providers and practice staff in the clinically integrated network (CIN) to communicate and promote best practices for billing, coding, documentation, and improved patient outcomes. RN Quality Ambulatory Care Coordinators review and share the quality performance of their assigned practices and work closely with Ambulatory Care Coordinators to identify barriers related to quality outcomes.
This position is remote with required local travel. Responsibilities Essential Key Job Responsibilities The key deliverables include: Pre and post visit documentation and claims auditing. Validate clinical documentation in conjunction with contracted HEDIS measures and best practices. Access clinical documentation for compliance in accordance with the American Medical Association and the Centers for Medicare and Medicaid Services Coding and Documentation guidelines, regulations of federal and state agencies and third party payers. Participate in external audit requests and special projects as needed. Working with a variety of systems and interfaces to achieve this accuracy Optimization of reimbursement Communication with patients and providers in a post-acute setting. Health promotion activities Identify barriers to quality outcomes/reimbursement and report them to the Quality Manager. Bi-monthly communication with assigned practices This position will report on the following key result areas and will take steps to recommend intervention in areas demonstrating less than optimal performance: Audit and project outcomes Improve reimbursement Collaboration, organization, and attention to detail are critical skill sets for this position. Access to sensitive initiatives and patient information may be necessary to perform these job duties; therefore ability to maintain confidentiality is a requirement. It is vital that an individual in this position be capable of good communication skills. It is of the utmost importance that written communication is legible. The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned. Qualifications Minimum Qualifications Required Education and Experience BSN required , Prior experience in direct patient care, care coordination, disease management, managed care. Experience navigating electronic medical records and healthcare claims data.
Required Licensure and Certifications RN, with current state licensure
Required Minimum Knowledge, Skills, Abilities and Training 5 years of clinical,case management and /or healthcare experience.
Experience working with Medicare and Medicaid populations.
Strong communication skills
Knowledge and experience with information technology
Ability to work autonomously within a matrix environment/remote workspace.
Dependable transportation for required travel
Experience in patient education and advocacy.
Motivational Interviewing
