Clinical Navigation Specialist

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General Statement: Community Health Provider Alliance (CHPA) is a non-profit Accountable Care Organization (ACO) formed around a statewide integrated network of federally qualified Community Health Centers (CHCs) in Colorado. Our mission is to provide patient-centered, cost-effective, high- quality integrated primary care and preventative services to Colorado’s low-income working families and individuals. CHPA leverages the strength of our CHC’s integrated primary care models which center the care around the patient by offering quality-based physical, behavioral, dental, specialty and ancillary  care at our clinics. Our patients benefit by having affordable high-quality comprehensive care provided  in their communities, in one location, focused on their full spectrum of health needs.

CHPA is participating in the Medicare Shared Savings Program (MSSP) with CMS, as well as numerous value-based contracts

This position supports medical record documentation, coding and quality measures in the Community Health Clinics (CHCs) participating in the CHPA Accountable Care Organization/Clinically Integrated Network.

The personnel in this position uses their knowledge of documentation guidelines, along with clinical skills and practice management knowledge to assist in any and all documentation audits and/or billing functions as determined by the CHPA team while ensuring that all quality measures are completed annually for the identified patient populations.

Responsibilities:

  1. Performs analysis on practice risk coding based on information from payers and reports, and creates a stratified plan to work with practices that have most opportunity or impact on the CHPA network
  2. Completes audits of documentation, coding and billing practices in assigned CHCs
  3. Provides education and training to office staff and/or providers in proper documentation and coding guidelines as necessary
  4. Reviews current STARs rating, identifies areas for gaps closure and provides quality documentation to appropriate payer resulting in gap closure for assigned CHCs
  5. Assists with all CHPA dashboard and scorecard initiatives to improve performance outcomes
  6. Queries providers on specificity of coding whenever there is question on specificity level
  7. Supports the creation of education that will train practice providers, billing, and support staff, as well as CHPA staff, for Medical Risk Adjustment/HCC coding opportunities
  8. Works in tandem with payers on specific documentation requirements, education materials, and training techniques.
  9. Maintains a database with the results of all medical chart reviews performed, with ability to report on statistics and practice progress on coding initiatives
  10. Works closely with payers and CHPA team on supporting special populations and focusing efforts in areas that need improvement. Closely communicating with the payer, the practice, and CHPA leadership.
  11. Assists in teaching any CHPA staff in proper documentation and coding guidelines as necessary
  12. Reports any issues to supervisor and the Data and Quality Teams as necessary Note: Employees are held accountable for all duties of this

Qualifications:

To achieve high-quality outcomes in primary care the Clinical Navigation Specialist is to have knowledge of HEDIS, CMS Hierarchical Condition Category (“HCC”) coding and billing guidelines, STARs measures, clinical standards, outcomes management skills. In this role, practice level support as well as payer partnerships will be imperative to success.

Knowledge, Skill, and Ability: [use words/phrases such as proficient in, ability to, solid knowledge of, or expert in; below are numerous examples to use or remove. For Example:]

  1. High School diploma or equivalent
  2. Minimum 2 years coding experience
  3. The American Academy of professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification preferred; CPC will be considered with MRA experience
  4. Experience with Risk Adjustment required
  5. Experience with clinic billing and coding required
  6. Knowledge of several EHR systems preferred; preferably Athena, eCW, and Epic
  7. Clinical background preferred
  8. Strong knowledge of CMS coding guidelines
  9. PowerPoint skills in preparing and delivering training
  10. Presentation skills to deliver training to clinical staff (coding staff and providers)
  11. Exceptional interpersonal, public speaking, and presentation skills. Clear and confident communicator internally and with members/external partners
  12. Intermediate knowledge of Microsoft Office applications, including Word, Excel and PowerPoint
  13. Adaptability – Maintaining effectiveness when experiencing major changes in work tasks or the work environment; adjusting effectively to work within new work structures, processes, requirements, or
  14. Ability to facilitate group discussions that challenge participants to consider various approaches/solutions.
  15. Managing Conflict – Dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more
  16. Ability to work independently; resourceful and proactive
  17. Passionate about improving the healthcare system
  18. Fluency in written and spoken English
  19. Solid knowledge of, and value for, cultural competence and diversity, equality, equity and
  20. Ability to travel within Colorado

The ideal candidate will display sound judgment, relate well to the public and staff, have a professional demeanor, prioritize customer satisfaction, and be well organized.

CHPA is an equal opportunity employer offering a generous benefits package, a casual work environment, and a competitive salary (DOE).
Category: Full-Time, Exempt Responsible to: CHPA CEO Supervises:  N/A
Job Description Effective Date: October 2020 Hiring Range: 44k – 66k
CHPA is an equal opportunity employer that provides a comprehensive benefits package that includes:

  • Insured group health, dental, & vison plans (NOTE: Medical Insurance may not be available for out of state employees)
  • Medical and dependent care flexible spending account options
  • 401k retirement plan with an employer contribution match
  • Life, AD&D, and Long-term disability plans paid for by employer
  • Free 24/7 access to confidential resources through an Employee Assistance Program (EAP)
  • Voluntary benefit plans to complement health care coverage including accident insurance, critical illness, and short-term disability
  • A generous mix of vacation, sick and holiday paid days off

To apply, please email Joseph Berry at joseph@chpanetwork.com.  Please include your resume and cover letter.