Sequent Quality Coding Specialist

The Quality Coding Specialist (QCS) is responsible for supporting the clinically integrated network’s (CIN) quality performance program and ensuring accurate and compliant coding practices to support value-based healthcare initiatives. The QCS will work to implement and optimize quality measure performance, drive patient engagement initiatives, and facilitate practice transformation to align with value-based programs. Serves as educational resource for physician practices and ensure they are informed and engaged in network clinical initiatives.  Responsible for reviewing and analyzing medical records, assessing the accuracy of diagnostic coding, and identifying opportunities for improvement in risk adjustment documentation and coding practices.

1. Support CINs' quality programs aimed at preventing illness and improving individual well-being, clinical outcomes and quality of life for patients with chronic conditions.
2. Maintain current technical understanding of quality measures (e.g. HEDIS, etc.) associated with value-based programs and develop strategies to improve performance and incorporate into operational workflows.
3. Ensure accurate data collection, reporting, and submission to payers for quality programs.
4. Work closely with healthcare providers, care teams, and patients to promote health education and self-management techniques.
5. Facilitate preventive screenings for patients and/or assists physician staff in scheduling patients as needed.
6. Analyze data related to quality measures, patient outcomes, and engagement initiatives.
7. Utilize data-driven approaches, evidence-based practices, and quality improvement methodologies to drive measurable improvements in healthcare processes and outcomes.
8. Monitor progress towards quality goals and recommend interventions to address gaps or deficiencies.
9. Foster effective relationships and communication with healthcare providers, administrators, payers, and other relevant stakeholders.
10. Support network practices in transitioning to value-based care model. Assesses current workflows, systems, and processes to identify areas for improvement.
11. Provide guidance and assistance to network practices in implementing practice transformation initiatives. Utilize data analytics to measure the impact of quality improvement interventions and recommend further improvements.
12. Develop and deliver training programs to network practice to enhance their understanding of <risk adjusted coding>
13. Collaborate with cross-functional teams to align initiatives, share insights, and promote a culture of continuous quality improvement.
14. Represents quality program on assigned committees.

REQUIRED

1. Bachelor’s degree in health sciences, public health, healthcare administration or related field or Certified Medical Assistant (CMA) certification and five (5) years of experience in ambulatory setting
2. Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) credential.
3. Two (2) year experience in ambulatory care, ICD-10-CM and CPT coding.
4. In-depth knowledge of risk adjustment coding methodologies, including HCC (Hierarchical Condition Category) coding.
5. Strong understanding of value-based care models, population health management, and quality improvement methodologies.

PREFERRED

1. Three (3) year experience in ambulatory care, ICD-10-CM and CPT coding.
2. One (1) year experience in coding quality auditing.
3. 2 years of relevant experience in value-based care / quality improvement role
4. Analytical skills necessary to analyze and interpret routine data.
5. Experienced user of clinical information systems (i.e. electronic health record, practice management systems, disease registries, clinical analytic systems)
6. Ability to work collaboratively with physicians and healthcare administrators
7. Ability to work independently with under general direction
8. Skill in oral and written communication