Job Category: Legal, Quality, ComplianceDegree Level: High School Diploma/GEDJob Description:Clark Regional Medical CenterWho We Are:People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Clark Regional Medical Center is a 79 bed community hospital featuring updated technology including new and expanded services such as Diagnostic Services, larger capacity Emergency Services, home-like Labor and Delivery Suites, and a skilled nursing facility. The campus also includes a 45,000 square foot Medical Plaza housing the Clark Clinic, Diagnostic Center for Women, Center for Rehabilitation, Specialty Clinic and Anticoagulation Clinic.Where We Are:Winchester offers a truly original experience to all with so much to do and see. Just a short drive from Lexington, the “Horse Capital of the World,” and the Red River Gorge, you can experience all the beauty and excitement nature has to offer.Why Choose Us:
Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
Competitive Paid Time Off
Employee Assistance Program - mental, physical, and financial wellness assistance
Tuition Reimbursement/Assistance for qualified applicants
Membership discounts with local gyms and community businesses
Free Parking
And much more…
Summary:Provides indirect and as needed direct patient care in the office / clinic setting. Maintains regulatory requirements and office / clinic policies, procedures and standards. Responsible for communication and education Provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-10/CPT coding. Identify open gaps in care and communicate to Providers and staff opportunities to close gaps to meet CMS Star Rating measures. Represents the organization with all insurance companies regarding health metrics.Reports to: Clinic LeaderFLSA: Non-exemptEEO: TechniciansMinimum Education:High school diploma or equivalent, RequiredAssociates' degree or two years of college, PreferredRequired Skills:Required critical thinking skills, detail orientated with decisive judgment and the ability to work with minimal supervision.Must be able to work in a stressful environment and take appropriate action.Must be flexible with work location assignments.Essential Functions:Collaborates with Physician Services to improve provider performance in areas of Quality, Risk Adjustment, Operations (Claims and encounters).Communicates with external data sources as needed to gather data necessary to measure identified outcomesSupports quality improvement program studies and HEDIS as needed, requesting records from providers, maintain databases and researching to identify members' provider encounter historyEstablishment and maintenance of quality measure flowsheets and Healthcare Quality Patient Assessment FormsAttend and participate in monthly Quality Learning Collaborative Coaching CallsMeet monthly with insurance representatives regarding CMS Stars ratingsReview Member Roster - Visit Detail to identify members needing visitsReview ED utilization reports and opportunities for improvementEducation office staff on quality metricsEEOC Statement:Clark Regional Medical Center is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.About Us: Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.About the Team: We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
