Quality Improvement Specialist, Coding

ROLE OVERVIEW  

We are looking for a highly skilled candidate to coordinate and execute quality improvement initiatives for clinical service lines using the Institute for Health Improvement (IHI) framework.  The ideal candidate has experience coding clinician treatment records and a strong understanding of health plan documentation requirements for behavioral/mental health. This candidate should be adept auditing Evaluation & Management and Psychotherapy encounters for compliance with CPT and ICD-10 guidelines. Additionally, this candidate should be comfortable analyzing data to identify trends and areas for improvement, as well as preparing reports for presentation to stakeholders with findings and recommendations.  

Location: Remote

Compensation: $45,000 - $65,000/annually

RESPONSIBILITIES 

• Provide training on quality improvement methodologies for identified projects.  

• Educate clinicians and non-clinical staff on best practices and new procedures. 

• Regularly monitor and evaluate the effectiveness of implemented changes. 

• Adjust strategies based on feedback and data analysis. 

• Ensure sustained improvements in mental health services. 

• Use Nationally Correct Coding Initiative (NCCI), CPT, ICD, HCPCS guidelines to judge the accuracy of coding/documentation in the treatment record. 

• Compare clinical documentation to charge slip or claim form to evaluate code level selection. 

• Navigate the Practice Management (PM) suite in the Electronic Medical Record to find patient accounts and identify any additional records that support clinician code selection. 

• Print patient records and send reporting to assigned health plans. 

• Identify and resolve any discrepancies found in a professional, ethical, and clinically compliant manner. 

• Identify opportunities to drive new initiatives for clinician education and auditing workflow enhancements. 

• Provide feedback as directed to clinical leaders and/or providers while maintaining patient confidentiality and professional boundaries. 

• Participate in cross-functional teams to collaboratively partner with other departments and stakeholders. 

SKILLS & EXPERIENCE 

• Current Professional Coding Certification (CPC or CPC-A) or comparable certification/degree. 

• Mastery of CPT requirements for Evaluation & Management and Psychotherapy codes; proficiency with behavioral health diagnosis coding ICD10 and DSM5. 

• Basic computer skills to include Office 365 (Microsoft Word and Excel). 

• Experience with Electronic Medical Records (AdvancedMD preferred) and HIPAA requirements. 

• Prior experience collaborating with Psychotherapists, Physicians, and Advanced Practice Clinicians. 

• Prior experience resolving prepay, postpay, and 3rd party claims audits. 

• Familiarity with health plan requirements and provider manuals. 

• Related experience with internal auditing of provider documentation code selection and medical necessity. 

• Knowledge of specialized interventional Psychiatry such as TMS, Zulresso, Spravato, Ketamine Infusion. 

• Knowledge of specialized psychological testing intervention codes. 

• Strong verbal and written communication skills. 

• Qualified candidates must be legally authorized to be employed in the United States. 

• LifeStance is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status. 

• Demonstrates awareness, inclusivity, sensitivity, humility, and experience in working with individuals from diverse ethnic backgrounds, socioeconomic statuses, sexual orientations, gender identities, and other various aspects of culture.