The Great Lakes Clinical Integrated Network IPA (GLIN IPA) Auditing Coordinator and Provider Educator will be responsible to develop and maintain effective compliance and education programs for coding and physician documentation as it relates to the successfulness of the quality contracts with GLIN IPA hold with its payer partners.

Essential Functions:

• Develop and implement financial, operational, and coding compliance policies and procedures that support and optimize an accurate depiction of a patient’s true heath status.
• Monitor the performance of coding & documentation functions on an ongoing basis against the federal/state laws/rules, third party payers and internal policies
• Plan and coordinate independent onsite investigations, assessments, and audits to assess compliance w/ applicable coding/billing requirements and internal policy
• Develop and implement an education program for all providers and staff. Provide on-going education to workforce members regarding accurate coding and proper use of modifiers for CPT, CPTII, DX, and Risk Adjustment coding as it relates to value-based contracts.
• Assist in problem solving and ongoing education of all providers, clinicians, and staff
• Develop an effective process for furnishing and disseminating information and guidance on applicable Medicare regulations, state statutes, regulations as well as federal, state and private payer insurance billing requirements
• Deliver exemplary customer service in order to provide a positive patient experience across the organization
• Perform other duties assigned by management

Minimum Requirements:

• Bachelor’s degree or equivalent experience in field, in lieu of Bachelor’s degree
• 5+ years of progressive coding experience
• Specialized Knowledge Needed for Performance of Job: Advanced knowledge of ICD-10, CPT, HCC, and other coding sets, experience developing and implementing education and audit programs (Intelicode)
• Special Skills: Minimum 3 years of experience preferred in team building, facilitation/training, and conflict resolution, with demonstrated ability to lead through influence, collaboration and consensus building. Experience with statistical sampling, survey methodology and clinical content of health records required. Excellent written, communication, and presentation skills with the ability to explain and write complex information in a clear, concise, and organized format required
• Other: Current certification as a CPC, CCS, CPMA, CEMA , CCS-P, RHIA, or RHIT and/or Compliance Certifications

Knowledge & Skills

• Solid understanding of health care industry, WNY provider community and a comprehensive knowledge of medical office flow, especially related to NCQA, PCMH, MACRA, CPC+, HEDIS, CMS and regulatory reporting.
• Excellent verbal and written communication skills coupled with an ability to create and present effective and persuasive public presentations.
• Proven developer, coach and mentor of people
• Ability to work in a fast-paced, collaborative environment, must be self-directed.
• Evidence of essential leadership, communication, education, and counselling skills.
• Ability to work with others that have a broad range of healthcare experience including physicians and administrative staff.
• Ability to work well under pressure, manage a team and multiple assignments simultaneously while maintaining quality standards and meeting assigned deadlines.
• Strong emotional intelligence and adept at building relationships.
• Valid driver’s license and acceptable driving history required for local travel involved with position (DMV check will be conducted). Out of state travel may be required.
• Intermediate level of proficiency with MS Word, Excel, PowerPoint, Microsoft Outlook, Salesforce
• High level of flexibility to travel, reschedule and re-direct as needed

We offer an outstanding benefits package including health, dental, 401K, vacation, and PTO, as well as a great working environment

Pay range: $60,000 to $75,000

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within job’s compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations

Equal Employment

Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network (GLIN) values diversity, inclusion, and equity as matters of fairness and effectiveness . We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged .

Great Lakes Clinical Integrated Network IPA (GLIN IPA) is an Equal Opportunity Employer.