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The Clinical Quality Review team is responsible for conducting investigations for various condition outcomes as part of Vatica visits to determine if conditions were documented and coded appropriately, as well as determining the root cause and person responsible to facilitate accurate clinical quality reporting. The Provider Educator/Quality Reviewer establishes and maintains relationships with all members of the Provider Education department. The Provider Educator/Quality Reviewer reports to the VP of Quality Programs. In this role, you will be responsible for understanding workflows, operational procedures, Vatica policies, cultural and process changes necessary for all lines of business.

The Provider Educator/Quality Reviewer is a subject matter expert (SME) and educates providers in the following areas:

• ICD-10 Coding
• AHA Coding Guidelines
• CMS Risk Adjustment Model (2008 Risk Adjustment Data Technical Assistance for Medicare Advantage Organizations Participant Guide)
• CMS Alternative Payment Models

Key Responsibilities

• Performs clinical code reviews to identify missed coding opportunities and attributes them to providers and/or internal clinical staff.
• Organizes, interprets, and logs data collected during condition reviews.
• Attends and participates in weekly department meetings.
• Maintains Vatica Health Provider Education Department Standards of Practice.
• Responds and tracks resolution for internal and external customer-related issues and requests through support ticketing process.
• Produces effective provider education materials.
• Establishes and maintains rapport with providers.
• Schedules and conducts provider education sessions.

Requirements

• A certified Nurse Practitioner (NP) or Physician Assistant (PA) with considerable clinical experience (3 to 5 years preferred.)
• Must have Certified Risk Adjustment Coder (CRC) certification (or attain CRC certification upon employment.)
• Excellent interpersonal skills that include the ability to effectively communicate with physician and mid-level providers.
• Excellent written and verbal communication skills.
• Exceptional organizational skills.
• Experience in a clinical care setting (preferred settings: internal medicine, critical care management, and/or intensive care)
• Aptitude in resolving issues and conflicts.
• Proficient with Diagnostic Coding, Billing, and Quality Measures.
• Understanding of Medicare, Medicaid, and Health Plan benefit structures.
• Flexible, energetic, self-starter, multi-tasker.
• Strong technical knowledge of technology, computers, software, EMR systems (including but not limited to Excel).
• Experience in provider relations is preferred.

Benefits

WORKING AT VATICA HEALTH ADVANTAGES

Prosperity

• Competitive salary based on your experience and skills we believe the top talent deserves the top dollar.
• Bonus Potential (based on role and is discretionary) if you go above and beyond, you should be rewarded.
• 401k plans we want to empower you to prepare for your future.
• Room for growth and advancement- we love our employees and want to develop within

Good Health

• Comprehensive Medical, Dental, and Vision insurance plans
• Tax-free Dependent Care Account
• Life insurance, short-term, and long-term disability

Happiness

• Excellent PTO policy (everyone deserves a vacation now and then)
• Great work-life balance environment- We believe family comes first!
• Strong supportive teams- There is always a helping hand when you need it.

The salary for a position is typically determined by multiple factors such as the individual's qualifications, experience, skills, and location. The projected compensation range for the position may vary based on these factors and could range from $95,000 to $125,000 (annualized USD). However, this estimate represents just one aspect of our total compensation package offered.

Are you up to the challenge? What are you waiting for? Apply today!