We are seeking a CDI/Quality Assurance Lead to support documentation improvement and coding efforts for practices participating in value-based contracts. This role is critical in ensuring that our practices deliver high-quality care to Medicare beneficiaries, while maintaining strict regulatory compliance.
The CDI/QA Lead will spearhead the development of quality assurance programs and CDI QA initiatives. The ideal candidate will possess strong analytical, organizational, and communication skills, with a keen attention to detail. A service-oriented mindset and proficiency in QA tools and software, along with fluency (or the ability to quickly master) Google Suite tools, are essential.
We are looking for candidates who are passionate about Aledade's physician-led ACO model and its ability to improve healthcare quality while reducing costs.
This is a remote position based in the U.S., with periodic travel to Aledade's headquarters in Bethesda, MD, and assigned markets.
Primary Duties
- Plan, develop, implement, and manage quality assurance programs across the organization's coding, billing and CDI (Clinical Documentation Improvement) functions. Oversee and monitor the effectiveness of the QA program, ensuring compliance and high performance; develop key performance indicators (KPIs) to assess quality and identify areas for process improvements; and implement process improvement strategies necessary to meet annual targets.
- Identify high risk areas and plan, monitoring activities to evaluate compliance with laws, regulations, policy and procedures, and coding and billing standards. Create and implement standardized audit monitoring methodology
- Ensure standard operating procedures (SOPs) and clinical templates are compliant with current applicable regulations, laws and guidance. Serve as a liaison and subject matter expert on regulatory compliance, clinical documentation, coding, and billing for both internal and external customers
Minimum Qualifications
- Bachelor's degree in Health Information Management or related healthcare field. 10 years of experience in lieu of the degree.
- Minimum 5 years of experience in a health plan or health system setting
- Minimum of 2 years of experience in Risk Adjustment
- Previous experience in a quality assurance program and extensive knowledge of state and federal regulations and guidelines pertaining to documentation and coding. Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models.
Preferred KSA's
- Active nursing credential as Registered Nurse (RN) or international MD
- Minimum of 4+ years of management experience
- Complete understanding of acuity levels for specific patient populations and strong clinical knowledge with the ability to interpret clinical documentation. Experience working directly with physician practices and individual providers to achieve demonstrable improvement of the accuracy and completeness of documentation and coding.
- Subject matter expertise on the Risk Adjustment program, methodology, and impact to value-based contracts across multiple lines of business (Medicare, Medicaid, & Commercial).
- Master's degree in health related fields.
Preferred Credentials (one or more of the following active credentials):
- RHIA - Registered Health Information Administrator (RHIA) - AHIMA
- RHIT - Registered Health Information Technician (RHIT) - AHIMA
- Certified Coding Specialist (CCS) - AHIMA
- Certified Documentation Improvement Practitioner (CDIP) - AHIMA
- Certified Clinical Documentation and Certification - Outpatient (CCDS-O) - ACDIS
- Certified Risk Coder (CRC) - AAPC
- Certified Professional Medical Auditor (CPMA) - AAPC
- Certified Professional Biller (CPB) - AAPC
- Rural Health Coding & Billing Specialist (RH-CBS) - ArchPro Coding
- Community Health Coding & Billing Specialist (CH-CBS) - ArchPro Coding
Salary Range: $91,000-$101,000 base + bonus + equity
Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience.