Job Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. 

Job Description

The OP CDI Specialist provides Risk Adjustment and Quality specific education to providers and all support staff through a variety of mediums including direct interactive learning sessions individually or in group settings, written guides and protocols, audits etc. This individual will apply clinical/coding knowledge, AHA coding clinic guidelines and prospective risk strategies to ensure accurate information is delivered to the provider at point of care. This position requires a deep understanding of medical coding practices, compliance regulations, and the ability to education physician/providers to accurate and complete coding practices. The goal of the role will be to oversee provider education and subsequently improve documentation accuracy across HCC coding. 

WHAT YOU’LL BE DOING

• Subject matter experts for proper risk adjustment coding/documentation and CMS data validation 
• Work in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director to ensure compliance of CMS risk adjustments guidelines are met 
• Analyze MRA data to identify patterns and development of interventions/education at the provider level to coordinate an educational work plan for providers 
• Conduct provider education and training regarding risk adjustment to help to ensure accurate and complete coding is achieved 
• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and Quality 
• Coordinates and facilitates risk adjustment education and training using a wide variety of methods and media to deliver content, including printed materials and technical reports, power point presentations, teleconference and videoconference platforms 
• Promote efforts to improve provider compliance with CMS requirements 
• Collaborate with other departments to enhance the total provider experience 
• Provides clear, concise and professional communication to varying audiences depending on the project and its goals 
• Deliver content professionally and customize to specific audiences 
• Works on additional risk adjustment audit requests 
• Serves on the RADV Committee as subject matter experts as needed (if applicable to client) 
• Assists in the development and identification of training focus areas that support documentation improvement 
• Perform quality assurance auditing  
• Complies with all policies and standard 

Qualifications

WHAT YOU'LL NEED TO HAVE 

• Certified through the American Academy of Professional Coders (AAPC) or equivalent.
• CPC or CRC (required) 
• 3 years of experience in risk adjustment coding 
• 2 years of experience in physician/provider education 
• Familiarity with CMS regulations for Risk Adjustment programs related to documentation and coding compliance for both Inpatient and Outpatient. 
• Familiarity with a variety of quality measures impacted by ICD-10 such as: 
• HEDIS 
• SDoH 
• Case Management 
• Strong understanding of primary care coding, workflows, and industry struggles/standards 
• Technology diversity in EHR (Epic, Cerner highly desired)
• Technology agile-Coding Platforms, AI Tools, and Analytics 
• Adheres to a moral and ethical framework in approaching work and servicing clients 
• Ability to work independently but also as part of a team environment 
• Self-motivated, highly organized, and detailed oriented 
• Excellent time management and ability to work on multiple projects simultaneously while monitoring deadlines and identifying resource conflicts 
• Ability to establish and maintain effective working relationships with employees, clients, and vendors (to the extent applicable). 

WHAT WE'D LOVE FOR YOU TO HAVE

 

• CDEO (preferred) 
• RN/LPN (preferred) 

 

Additional Information

The salary range for this position is $80,000.00 to $88,000.00 per year

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.

Job Tags

Weekly pay, Full time, Local area, Work from home, Flexible hours,

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