Clinical Navigation Specialist

Community Health Provider Alliance (CHPA)
Published
June 7, 2021
Location
Denver, CO
Category
Job Type

Description

Community Health Provider Alliance (CHPA)
Job Description
____________________________________________________________________________

Job Title: Clinical Navigation Specialist
Reports to: Risk Adjustment Coding Manager
Supervises: n/a
Category: Full-time, Exempt

Purpose of Position:
This position supports medical record documentation, coding and quality measures in the Community
Health Clinics (CHCs) participating in the CHPA Accountable Care Organization/Clinically Integrated
Network.
The personnel in this position uses their knowledge of documentation guidelines, along with clinical
skills and practice management knowledge to assist in any and all documentation audits and/or
billing functions as determined by the CHPA team while ensuring that all quality measures are
completed annually for the identified patient populations.

Essential Duties/Responsibilities:
1. Performs analysis on practice risk coding based on information from payers and reports, and
creates a stratified plan to work with practices that have most opportunity or impact on the
CHPA network
2. Completes audits of documentation, coding and billing practices in assigned CHCs
3. Provides education and training to office staff and/or providers in proper documentation and
coding guidelines as necessary
4. Reviews current STARs rating, identifies areas for gaps closure and provides quality
documentation to appropriate payer resulting in gap closure for assigned CHCs
5. Assists with all CHPA dashboard and scorecard initiatives to improve performance outcomes

Other Duties/Responsibilities:
1. Queries providers on specificity of coding whenever there is question on specificity level
2. Supports the creation of education that will train practice providers, billing, and support
staff, as well as CHPA staff, for Medical Risk Adjustment/HCC coding opportunities
3. Works in tandem with payers on specific documentation requirements, education materials, and
training techniques.
4. Maintains a database with the results of all medical chart reviews performed, with ability to
report on statistics and practice progress on coding initiatives
5. Works closely with payers and CHPA team on supporting special populations and focusing
efforts in areas that need improvement. Closely communicating with the payer, the practice,
and CHPA leadership.
6. Assists in teaching any CHPA staff in proper documentation and coding guidelines as necessary
7. Reports any issues to supervisor and the Data and Quality Teams as necessary
Note: Employees are held accountable for all duties of this job.

Job Qualifications:
To achieve high-quality outcomes in primary care the Clinical Navigation Specialist is to have
knowledge of HEDIS, CMS Hierarchical Condition Category ("HCC") coding and billing guidelines, STARs
measures, clinical standards, outcomes management skills. In this role, practice level support as
well as payer partnerships will be imperative to success.

Knowledge, Skill, and Ability: [use words/phrases such as proficient in, ability to, solid knowledge
of, or expert in; below are numerous examples to use or remove. For Example:]
1. Strong knowledge of CMS coding guidelines
2. Exceptional interpersonal, public speaking, and presentation skills. Clear and confident
communicator internally and with members/external partners
3. Intermediate knowledge of Microsoft Office applications, including Word, Excel and PowerPoint
4. Adaptability - Maintaining effectiveness when experiencing major changes in work tasks or the
work environment; adjusting effectively to work within new work structures, processes,
requirements, or cultures.
5. Ability to facilitate group discussions that challenge participants to consider various
approaches/solutions.
6. Managing Conflict - Dealing effectively with others in an antagonistic situation; using
appropriate interpersonal styles and methods to reduce tension or conflict between two or more
people.
7. Ability to work independently; resourceful and proactive
8. Passionate about improving the healthcare system
9. Fluency in written and spoken English
10. Solid knowledge of, and value for, cultural competence and diversity, equality, equity and
inclusion.
11. Ability to travel within Colorado

Training/Education:
1. High School diploma or equivalent
2. Minimum 2 years coding experience
3. The American Academy of professional Coders (AAPC) Certified Risk Adjustment Coder (CRC)
certification preferred; CPC will be considered with MRA experience

Experience:
1. Experience with clinic billing and coding required
2. Knowledge of several EHR systems preferred; preferably Athena, eCW, and Epic
3. Clinical background preferred

Working Environment and Physical Activities
1. General Office Environment work from home
2. Ability to travel. This position typically requires travel to meetings within the state of
Colorado. Additional travel may also be required, with approximately three in-state overnight
trips per year

Note: This job description is not intended to be an exhaustive list of all duties, responsibilities,
or qualifications associated with the job.

Position Salary Range: $21.15 - $31.73 (44k-66k annually) per hour depending on experience [this is
the range that the employer needs to be willing to offer, not the min. and max for the position]

Benefits: CCHN provides a comprehensive benefits package that includes:
1. Insured group health, dental, & vison plans
2. Medical and dependent care flexible spending account options
3. 401k retirement plan with an employer contribution match
4. Life, AD&D, and Long-term disability plans paid for by employer
5. Free 24/7 access to confidential resources through an Employee Assistance Program (EAP)
6. Voluntary benefit plans to complement health care coverage including accident insurance,
critical illness, and short-term disability
7. A generous mix of vacation, sick and holiday paid days off

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