Senior OP CDI Specialist

WHO IS GUIDEHEALTH? 

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers. As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices prioritizing delivering high-quality healthcare focused on outcomes and value. 

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events. This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients. 

Join us as we put healthcare on a better path!!  

This position is fully remote but will require travel to client locations (10% max). We are only accepting applications for local candidate able to travel to the Atlanta area as needed. We thank you for your understanding.

The Senior OP CDI Specialist provides Risk Adjustment and Quality specific education to providers and all support staff through a variety of mediums including direct interactive learning sessions individually or in group settings, written guides and protocols, audits etc. This individual will apply clinical/coding knowledge, AHA coding clinic guidelines and prospective risk strategies to ensure accurate information is delivered to the provider at point of care. This individual will aid in training of new staff and lead coding educational content creation. This position requires a deep understanding of medical coding practices, compliance regulations, and the ability to education physician/providers to accurate and complete coding practices. The goal of the role will be to oversee provider education and subsequently improve documentation accuracy across HCC coding.

Senior OP CDI Specialist Duties:

• Leads coding educational content creation efforts in collaboration with marketing and leadership
• Trains and onboards new staff to the diagnosis accuracy team
• Leads cross departmental training initiatives and efforts
• Subject matter experts for proper risk adjustment coding/documentation and CMS data validation
• Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director to ensure compliance of CMS risk adjustments guidelines are met
• Analyze MRA data to identify patterns and development of interventions/education at the provider level to coordinate an educational work plan for providers
• Conduct provider education and training regarding risk adjustment to help to ensure accurate and complete coding is achieved
• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and Quality
• Coordinates and facilitates risk adjustment education and training using a wide variety of methods and media to deliver content, including printed materials and technical reports, power point presentations, teleconference and videoconference platforms
• Promote efforts to improve provider compliance with CMS requirements
• Collaborate with other departments to enhance the total provider experience
• Provides clear, concise and professional communication to varying audiences depending on the project and its goals
• Deliver content professionally and customize to specific audiences
• Works on additional risk adjustment audit requests
• Serves on the RADV Committee as subject matter experts as needed (if applicable to client)
• Assists in the development and identification of training focus areas that support documentation improvement
• Perform quality assurance auditing 
• Complies with all policies and standard

Education and Training:

• Certified through the American Academy of Professional Coders (AAPC) or equivalent.
  • CPC (required) CRC (required)
  • CDEO (preferred)
  • RN/LPN (preferred)

Experience:

• 7 years of experience in risk adjustment coding
• 5 years of experience in physician/provider education

Additional Skills:

• Familiarity with CMS regulations for Risk Adjustment programs related to documentation and coding compliance for both Inpatient and Outpatient.
• Familiarity with a variety of quality measures impacted by ICD-10 such as:
  • HEDIS
  • SDoH
  • Case Management
• Strong understanding of primary care coding, workflows, and industry struggles/standards
• Technology diversity in EHR (Epic, Cerner highly desired)
• Technology agile-Coding Platforms, AI Tools, and Analytics
• Adheres to a moral and ethical framework in approaching work and servicing clients
• Ability to work independently but also as part of a team environment
• Self-motivated, highly organized, and detailed oriented
• Excellent time management and ability to work on multiple projects simultaneously while monitoring deadlines and identifying resource conflicts
• Ability to establish and maintain effective working relationships with employees, clients, and vendors (to the extent applicable).

COMPENSATION 

Guidehealth’s compensation structure includes more than just base salary. We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match. Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need. 

The base pay range for this role is $99,500.00 per year paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications. 

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager.