Position Description

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.

Position Requirements

REQUIRED

 

Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) credential. Three (3) year experience in ambulatory care setting, responsible for ICD-10-CM and CPT coding. In-depth knowledge of risk adjustment coding methodologies, including HCC (Hierarchical Condition Category) coding. Strong understanding of value-based care models, population health management, and quality improvement methodologies.

PREFERRED

 

Bachelor’s degree in health sciences, public health, healthcare administration or related field One (1) year experience in coding quality auditing. Two (2) years of relevant experience in value-based care / quality improvement role Analytical skills necessary to analyze and interpret routine data. Experienced user of clinical information systems (i.e. electronic health record, practice management systems, disease registries, clinical analytic systems) Ability to work collaboratively with physicians and healthcare administrators Ability to work independently with under general direction Skill in oral and written communication

Service Area Overview