RN OP CDI Provider Edu & Qual Specialist

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

9/22/2024

Entity:

Wisconsin

Job Code:

440013

Job Title:

RN OP CDI Provider Edu & Qual Specialist

FLSA Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

The RN – Outpatient CDI Provider Education and Quality Specialist is responsible for enhancing the understanding and application of Hierarchical Condition Category (HCC) coding among healthcare providers within the organization. This role involves designing and delivering training programs, developing educational materials, and providing ongoing support to ensure accurate OP CDI, risk adjustment coding and documentation practices. The goal is to improve the quality of Outpatient documentation, optimize risk adjustment scores, and support overall patient care and reimbursement processes.

The incumbent will be responsible for one-on-one and small group provider education on OP clinical documentation best practices and workflows within UW Health. The incumbent will collaborate extensively with departments across UWH, including, but not limited to: Coding, Population Health, Ambulatory Operations, Revenue Cycle, Physicians and APPs.

The incumbent requires an advanced knowledge of medical and coding terminology, anatomy, disease processes, expected healthcare outcome, prospective payment systems.

ESSENTIAL DUTIES

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Develop and deliver training programs on HCC coding and risk adjustment for UW Health Ambulatory providers, including physicians and APPs.

•

Create educational materials such as presentations, tip sheets and e-learning modules that address current best practices in risk adjustment documentation and coding.

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Conduct regular small group and 1:1 training to address specific learning needs and keep providers updated on changes in coding guidelines and regulations.

•

Review and analyze outpatient provider documentation and coding practices to identify areas for improvement.

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Provide feedback and guidance to providers on enhancing documentation accuracy and completeness to support appropriate HCC coding.

•

Collaborate extensively with UW Health providers to ensure that clinical documentation supports the coding of all relevant conditions and diagnoses based on industry best practices.

•

Consult, collaborate, and offer expert advice on risk adjustment documentation.

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Work collaboratively with team members of Coding, CDI, Compliance, Population Health, Clinical Leadership and Medical Directors to identify trends and possible solutions to optimize HCC documentation align training initiatives with organizational goals and regulatory requirements.

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Serve as a subject matter expert for providers with questions or concerns related to HCC coding and documentation.

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Collaborate with Coding/CDI team to develop and produce handouts, fact sheets, pocket guides, and electronic health record alerts with coding terminology and frequently asked questions.

•

Monitor and evaluate the effectiveness of training programs and documentation practices through audits and performance metrics.

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Implement corrective action plans and continuous improvement strategies based on internal audit findings and feedback.

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Stay current with changes in coding guidelines, regulations, and industry best practices to ensure provider training and documentation practices remain up-to-date.

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Maintains knowledge of ICD-10-CM/PCS coding and clinical documentation guidelines, regulations, developments, and practices via continuing education courses, professional organizations, seminars, reading current literature.

•

Design and implement new educational programs and resources as needed to address emerging challenges or changes in the risk adjustment landscape.

•

Evaluate and integrate feedback from providers and other stakeholders to continuously refine and improve educational offerings.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Clinical

(Select all that apply)

JOB REQUIREMENTS

Bachelor's Degree

in Nursing

Required

Master's Degree

in Nursing

Preferred

2 years

of Outpatient CDI experience

Required

or

2 years

of HCC Risk Adjustment experience

Required

3 years

of CDI experience in an AMC or HCC risk adjustment experience in an AMC

Preferred

Experience with risk adjustment coding quality improvement projects

Preferred

Training experience

Preferred

Licensed as a Registered Nurse (RN) in the State of WI or holds a license issued by a jurisdiction that has adopted the nurse licensure compact

Upon Hire

Required

Certified Clinical Documentation Specialist – Outpatient (CCDS-O)

Preferred

Certified Professional Coder (CPC)

Preferred

Certified Risk Adjustment Coder (CRC)

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Maintain strong broad-based coding, CDI knowledge, and understanding of pathology/physiology of disease processes and expected health care outcomes to provide guidance to team members.

•

In-depth knowledge of HCC coding principles, risk adjustment methodologies, and healthcare documentation standards.

•

Strong communication and presentation skills with the ability to convey complex information clearly and effectively.

•

Experience with data analysis and the ability to use data to drive improvements in coding and documentation practices.

•

Proficiency in Microsoft Office Suite and familiarity with electronic health record (EHR) systems.

•

Exceptional critical thinking skills

•

Strong and effective verbal and written communication skills

•

Excellent analytical skills

•

Excellent interpersonal skills

•

Ability to work independently as part of an interdisciplinary team

•

Ability to exercise good judgment

•

Ability to work independently and self-motivate as well as motivate others

•

Ability to meet deadlines

•

Ability to problem solve and make independent decisions

•

Ability to multi-task

•

Ability to collaborate and promote teamwork

•

Analytical skills with ability to manipulate and interpret data

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

☐

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.