Cano Health
Overview
QA Coordinator, Coding & Billing – Cano Health Join Cano Health to contribute to a team focused on making an impact in primary care. This role collaborates with physicians, nursing staff, and coding staff to improve the quality and completeness of patient care documentation and coding necessary for CMS data submission. Facilitates concurrent modifications to clinical documentation to support commensurate reimbursement for services rendered. Essential Duties & Responsibilities
Educate coding team on CMS coding guidelines and appropriate Risk Adjustment procedures to ensure adherence to CMS standards. Build and generate reports from the EMR system. Review concurrent medical records for compliance, including completeness and accuracy of severity of illness (SOI) and quality. Coach coders as assigned by regions, guiding daily workflow activities. Communicate with staff to ensure accurate and complete clinical documentation and to prevent inappropriate coding. Participate in meetings, provide feedback on issues, and present educational opportunities as needed. Support timely, accurate, and complete documentation used for measuring and reporting physician and facility outcomes. Educate physician and clinical staff on accurate and effective clinical documentation. Ensure the overall quality and completeness of clinical documentation to accurately represent severity, acuity, and risk of mortality. Collaborate with data teams to identify potential gaps related to Risk Adjustment. Work with the QA team to maintain proper education and capture chronic conditions appropriately. Additional Duties & Responsibilities
Knowledge: Prior knowledge with ECW, coding guidelines, Microsoft Office; fluency in English and Spanish preferred. Collaborates: Engage with Cano team, other medical offices, insurance companies, and patients to ensure high-quality patient care. Education & Experience
Minimum two (2) years coding experience with AAPC/AHIMA certifications. Minimum two (2) years QA experience. Proficient in Microsoft Word and Excel. Strong organization, training, and process management skills. Strong collaboration and relationship-building skills. Excellent written and verbal communication skills. Ability to learn new tasks and concepts. Required/Preferred
Education Requirements
Discipline
High School Knowledge, Skills & Proficiencies
Ability to analyze and interpret clinical information in the patient’s medical record. Recognizes opportunities for documentation improvement using critical thinking; balances reimbursement with regulatory compliance. Working knowledge of DRG formulation, Coding Guidelines, and Coding Clinic guidance. Strong written and verbal communication skills; ability to effectively communicate with physicians and clinicians. Knowledge of healthcare regulations, reimbursement, and documentation requirements. Applies medical terminology and procedures to evaluate clinical documents. Physical Requirements
This position works under typical office conditions. Must be able to work at a computer and on the phone for extended periods. Ability to stand, sit, walk, and occasionally climb. May require extended and flexible hours and weekends. Physical demands include lifting up to 50 lbs. Reasonable accommodations may be made for disabilities. Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasional climbing. Travel Requirements
0-25% travel; travel to assigned clinics may be required. Tools & Equipment Used
Computer and peripherals, standard and customized software applications, and usual office equipment. Disclaimer
The duties described are a general indication of the work and not an exhaustive list. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Seniority level
Mid-Senior level Employment type
Full-time Job function
Quality Assurance Industries
Hospitals and Health Care
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QA Coordinator, Coding & Billing – Cano Health Join Cano Health to contribute to a team focused on making an impact in primary care. This role collaborates with physicians, nursing staff, and coding staff to improve the quality and completeness of patient care documentation and coding necessary for CMS data submission. Facilitates concurrent modifications to clinical documentation to support commensurate reimbursement for services rendered. Essential Duties & Responsibilities
Educate coding team on CMS coding guidelines and appropriate Risk Adjustment procedures to ensure adherence to CMS standards. Build and generate reports from the EMR system. Review concurrent medical records for compliance, including completeness and accuracy of severity of illness (SOI) and quality. Coach coders as assigned by regions, guiding daily workflow activities. Communicate with staff to ensure accurate and complete clinical documentation and to prevent inappropriate coding. Participate in meetings, provide feedback on issues, and present educational opportunities as needed. Support timely, accurate, and complete documentation used for measuring and reporting physician and facility outcomes. Educate physician and clinical staff on accurate and effective clinical documentation. Ensure the overall quality and completeness of clinical documentation to accurately represent severity, acuity, and risk of mortality. Collaborate with data teams to identify potential gaps related to Risk Adjustment. Work with the QA team to maintain proper education and capture chronic conditions appropriately. Additional Duties & Responsibilities
Knowledge: Prior knowledge with ECW, coding guidelines, Microsoft Office; fluency in English and Spanish preferred. Collaborates: Engage with Cano team, other medical offices, insurance companies, and patients to ensure high-quality patient care. Education & Experience
Minimum two (2) years coding experience with AAPC/AHIMA certifications. Minimum two (2) years QA experience. Proficient in Microsoft Word and Excel. Strong organization, training, and process management skills. Strong collaboration and relationship-building skills. Excellent written and verbal communication skills. Ability to learn new tasks and concepts. Required/Preferred
Education Requirements
Discipline
High School Knowledge, Skills & Proficiencies
Ability to analyze and interpret clinical information in the patient’s medical record. Recognizes opportunities for documentation improvement using critical thinking; balances reimbursement with regulatory compliance. Working knowledge of DRG formulation, Coding Guidelines, and Coding Clinic guidance. Strong written and verbal communication skills; ability to effectively communicate with physicians and clinicians. Knowledge of healthcare regulations, reimbursement, and documentation requirements. Applies medical terminology and procedures to evaluate clinical documents. Physical Requirements
This position works under typical office conditions. Must be able to work at a computer and on the phone for extended periods. Ability to stand, sit, walk, and occasionally climb. May require extended and flexible hours and weekends. Physical demands include lifting up to 50 lbs. Reasonable accommodations may be made for disabilities. Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasional climbing. Travel Requirements
0-25% travel; travel to assigned clinics may be required. Tools & Equipment Used
Computer and peripherals, standard and customized software applications, and usual office equipment. Disclaimer
The duties described are a general indication of the work and not an exhaustive list. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Seniority level
Mid-Senior level Employment type
Full-time Job function
Quality Assurance Industries
Hospitals and Health Care
#J-18808-Ljbffr