Apogeebehavioralmedicine
Senior Clinical Informatics & Quality Lead
Apogeebehavioralmedicine, Raleigh, North Carolina, United States
Senior Clinical Informatics & Quality Lead
As the
Senior Clinical Informatics & Quality Lead , you will act as the architect of our clinical operations. This is a senior individual contributor role operating at the intersection of clinical care, technology, and regulatory compliance. You will function primarily as a
Process Designer and Project Lead , working directly with Subject Matter Experts (SMEs) to translate complex clinical needs into streamlined, efficient workflows. You are the guardian of our “Operational Source of Truth,” ensuring that every workflow is not only well-designed and documented but also rigorously compliant. In addition to design, you play a critical role in
Quality Assurance . You will operationalize our Coding and Compliance Program by executing audits, managing provider tiers, and serving as a lead educator. You ensure our clinicians are fluent in our systems and protected by our compliance standards. Responsibilities
1. Operational Design & Workflow Architecture (Approx. 50%)
Workflow Architecture & Design:
Serve as the organization’s primary “Process Designer.” Translate abstract clinical goals into concrete, step-by-step operational workflows. Lead “Discovery” phases with SMEs to map current states, utilizing process mapping tools to identify friction points, redundancies, or “note bloat.” Design optimized future-state workflows that balance clinical reality with operational efficiency, ensuring systems work for the provider, not against them.
Project Management & Implementation:
Act as the Project Lead for operational initiatives, managing the full lifecycle from proposal to implementation. Coordinate cross-functional teams to ensure new processes are technically feasible within the EHR and sustainable for staff. Own the
Systemic Issue Log (SIL) , tracking systemic deficits and driving
Systemic Corrective Action Plans (S-CAPs)
to resolution.
Documentation & Knowledge Management:
Own the library of Standard Operating Procedures (SOPs) and internal policies. You are responsible for the hierarchy, maintenance, and accuracy of this documentation. Ensure “How we do things” is version-controlled and easily searchable, retiring outdated policies to prevent confusion.
2. Coding, Compliance & Auditing (Approx. 25%)
Audit Operations & Lifecycle Management:
Manage a
risk-based compliance framework
rather than a static schedule. You will determine audit frequency for each clinician (ranging from intensive monthly reviews to semi-annual checks) based on their specific accuracy scores and risk profile. Execute the full audit lifecycle: selecting charts (using both random and focused sampling), objectively scoring documentation against AMA/CMS guidelines, and verifying medical necessity for billed services. Serve as the organization’s “Internal Auditor,” ensuring that our documentation protects the company against external payer audits, clawbacks, and revenue risks.
Monitor
Coding Integrity KPIs
(e.g., E/M Level Accuracy, Diagnosis Specificity) to detect subtle compliance drifts, such as “note bloat” or cloning. Analyze
Revenue Cycle KPIs
(specifically coding-related denials) to distinguish between simple provider errors and larger systemic issues. Identify and flag vulnerabilities—such as consistent under-coding or lack of specificity—before they attract external scrutiny. 3. Education & Provider Support (Approx. 25%)
Partner with the Onboarding Team to lead the “Workflow Fluency” track for new clinicians. Serve as the primary educator for
Billing and Coding , ensuring all new hires achieve proficiency in documentation standards and regulatory requirements during their initial 90-day “Tier 1” period. Real-Time Feedback & Auditing Interventions:
Execute the “Real-Time Education” model, establishing immediate feedback loops with providers when errors are detected. Conduct collaborative, one-on-one intervention sessions to review audit findings, focusing on education rather than punitive measures. Manage educational remediation for providers on Corrective Education Plans (CEP), delivering focused training modules to close knowledge gaps.
Qualifications
Education & Licensure
Required:
Bachelor of Science in Nursing (BSN) or Master’s in Health Informatics / Nursing Informatics. Required:
Certification in Medical Auditing ( CPMA ) or willingness to obtain within 6 months of hire. Preferred:
Certified Professional Coder ( CPC ) or extensive experience with behavioral health documentation. Experience
Informatics & Design:
Minimum 3 years of experience in Clinical Informatics, Process Improvement, or a similar role where workflow design and EHR optimization were primary responsibilities. Clinical Background:
Clinical experience (RN/BSN) is essential to bridge the gap between administrative requirements and clinical reality. Auditing:
Demonstrated experience with medical record auditing, coding guidelines, and delivering feedback to clinicians. Skills
“The Designer Mindset”:
Ability to visualize complex systems and design elegant solutions. Proficiency with flowcharting/mapping tools (e.g., Visio, Lucidchart, Figma) is required. Technical Proficiency:
Deep understanding of EHR structures, templates, and logic to prevent compliance risks. Regulatory Knowledge:
Strong working knowledge of CPT, ICD-10, and documentation guidelines. Communication:
Exceptional ability to teach complex technical or regulatory concepts to clinical staff in a supportive manner. Commitment
A deep commitment to the philosophy that compliance is proactive, educational, and protective, and that good design improves the lives of our providers.
#J-18808-Ljbffr
As the
Senior Clinical Informatics & Quality Lead , you will act as the architect of our clinical operations. This is a senior individual contributor role operating at the intersection of clinical care, technology, and regulatory compliance. You will function primarily as a
Process Designer and Project Lead , working directly with Subject Matter Experts (SMEs) to translate complex clinical needs into streamlined, efficient workflows. You are the guardian of our “Operational Source of Truth,” ensuring that every workflow is not only well-designed and documented but also rigorously compliant. In addition to design, you play a critical role in
Quality Assurance . You will operationalize our Coding and Compliance Program by executing audits, managing provider tiers, and serving as a lead educator. You ensure our clinicians are fluent in our systems and protected by our compliance standards. Responsibilities
1. Operational Design & Workflow Architecture (Approx. 50%)
Workflow Architecture & Design:
Serve as the organization’s primary “Process Designer.” Translate abstract clinical goals into concrete, step-by-step operational workflows. Lead “Discovery” phases with SMEs to map current states, utilizing process mapping tools to identify friction points, redundancies, or “note bloat.” Design optimized future-state workflows that balance clinical reality with operational efficiency, ensuring systems work for the provider, not against them.
Project Management & Implementation:
Act as the Project Lead for operational initiatives, managing the full lifecycle from proposal to implementation. Coordinate cross-functional teams to ensure new processes are technically feasible within the EHR and sustainable for staff. Own the
Systemic Issue Log (SIL) , tracking systemic deficits and driving
Systemic Corrective Action Plans (S-CAPs)
to resolution.
Documentation & Knowledge Management:
Own the library of Standard Operating Procedures (SOPs) and internal policies. You are responsible for the hierarchy, maintenance, and accuracy of this documentation. Ensure “How we do things” is version-controlled and easily searchable, retiring outdated policies to prevent confusion.
2. Coding, Compliance & Auditing (Approx. 25%)
Audit Operations & Lifecycle Management:
Manage a
risk-based compliance framework
rather than a static schedule. You will determine audit frequency for each clinician (ranging from intensive monthly reviews to semi-annual checks) based on their specific accuracy scores and risk profile. Execute the full audit lifecycle: selecting charts (using both random and focused sampling), objectively scoring documentation against AMA/CMS guidelines, and verifying medical necessity for billed services. Serve as the organization’s “Internal Auditor,” ensuring that our documentation protects the company against external payer audits, clawbacks, and revenue risks.
Monitor
Coding Integrity KPIs
(e.g., E/M Level Accuracy, Diagnosis Specificity) to detect subtle compliance drifts, such as “note bloat” or cloning. Analyze
Revenue Cycle KPIs
(specifically coding-related denials) to distinguish between simple provider errors and larger systemic issues. Identify and flag vulnerabilities—such as consistent under-coding or lack of specificity—before they attract external scrutiny. 3. Education & Provider Support (Approx. 25%)
Partner with the Onboarding Team to lead the “Workflow Fluency” track for new clinicians. Serve as the primary educator for
Billing and Coding , ensuring all new hires achieve proficiency in documentation standards and regulatory requirements during their initial 90-day “Tier 1” period. Real-Time Feedback & Auditing Interventions:
Execute the “Real-Time Education” model, establishing immediate feedback loops with providers when errors are detected. Conduct collaborative, one-on-one intervention sessions to review audit findings, focusing on education rather than punitive measures. Manage educational remediation for providers on Corrective Education Plans (CEP), delivering focused training modules to close knowledge gaps.
Qualifications
Education & Licensure
Required:
Bachelor of Science in Nursing (BSN) or Master’s in Health Informatics / Nursing Informatics. Required:
Certification in Medical Auditing ( CPMA ) or willingness to obtain within 6 months of hire. Preferred:
Certified Professional Coder ( CPC ) or extensive experience with behavioral health documentation. Experience
Informatics & Design:
Minimum 3 years of experience in Clinical Informatics, Process Improvement, or a similar role where workflow design and EHR optimization were primary responsibilities. Clinical Background:
Clinical experience (RN/BSN) is essential to bridge the gap between administrative requirements and clinical reality. Auditing:
Demonstrated experience with medical record auditing, coding guidelines, and delivering feedback to clinicians. Skills
“The Designer Mindset”:
Ability to visualize complex systems and design elegant solutions. Proficiency with flowcharting/mapping tools (e.g., Visio, Lucidchart, Figma) is required. Technical Proficiency:
Deep understanding of EHR structures, templates, and logic to prevent compliance risks. Regulatory Knowledge:
Strong working knowledge of CPT, ICD-10, and documentation guidelines. Communication:
Exceptional ability to teach complex technical or regulatory concepts to clinical staff in a supportive manner. Commitment
A deep commitment to the philosophy that compliance is proactive, educational, and protective, and that good design improves the lives of our providers.
#J-18808-Ljbffr