Clinical Performance Educator

The Clinical Performance Educator plays a pivotal role in enhancing the quality of care provided to value based patients by ensuring comprehensive and proactive management of their healthcare needs. This multifaceted position involves overseeing patient care between visits, analyzing performance indicators, providing educational support to healthcare providers, and facilitating adherence to regulatory requirements.

Key Responsibilities:

·         Patient Care Coordination:

-          Monitor the healthcare needs of value-based care patients between visits.

-          Conduct follow-up assessments, including recent hospitalizations and referral status.

-          Ensure accurate and thorough documentation in patient charts.

·         Performance Analysis and Reporting:

-          Analyze performance indicators to identify trends and areas for improvement.

-          Develop formal presentations to report findings to leadership and providers.

-          Offer actionable recommendations to enhance documentation accuracy and coding practices.

·         HEDIS Score Monitoring:

-          Monitor and track HEDIS scores, coordinating the submission of supplementary data as required.

·         Education and Training:

-          Educate providers on CMS-HCC Risk Adjustment program and its impact on payment methodology.

-          Conduct training sessions on ICD-10-HCC coding and documentation best practices.

-          Deliver condition-specific presentations to enhance provider understanding and compliance.

·         Provider Support and Training:

-          Assist providers in utilizing EMR tools effectively to improve documentation and coding.

-          Identify providers for Medicare Risk Adjustment training and provide ongoing support.

-          Facilitate coding presentations and training sessions for clinicians, practice managers, and certified coders.

·         Regulatory Compliance:

-          Ensure compliance with state and federal regulations related to documentation, billing, and coding.

-          Attend payer meetings, as needed.

-          Provide feedback to providers and coders regarding documentation practices to ensure compliance.

Qualifications:

·         Strong understanding of CMS-HCC Risk Adjustment program and its implications.

·         Proficiency in ICD-10 coding and documentation requirements.

·         Excellent communication and presentation skills.

·         Microsoft Excel proficiency required.

·         Ability to work collaboratively in a dynamic healthcare environment.

·         Certified Professional Coder (CPC) certification a plus

Education and Experience:

·         Advanced practice degree (NP, PA)

·         Minimum of 3 years of experience in population health management or clinical education.

·         Previous experience in healthcare quality improvement initiatives is required.

·         Demonstrated experience in creating scalable processes and procedures within a healthcare delivery system also required.

This job description outlines the primary responsibilities and qualifications required for the Clinical Performance Educator position. The ideal candidate will possess a blend of clinical expertise, analytical skills, and educational proficiency to drive continuous improvement in patient care and provider performance.