Position Summary
The Clinical Documentation Improvement Specialist is responsible for facilitating the improved quality, accuracy and completeness of medical record documentation. This position will implement proactive measures to improve data quality, appropriate risk stratification of HCN’s VBS population and overall improvement in quality of care.
Position Responsibilities
- Serves as a subject matter expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and Risk Adjustment guidance
- Conducts proactive review of the medical record documentation including diagnosis coding, identification of co-morbidities and complications, and all appropriate secondary diagnoses
- Identifies issues and trends in coding and documentation that affect patient risk scores
- Works collaboratively with contracted health plans on risk adjustment initiatives; participates in auditing requests, reviews and assesses health plan results, and designs performance improvement plans as needed
- Develops and delivers provider and coder trainings, detailing coding best practices and provider level opportunities for improvement
- Provides education to providers, supporting clinical care teams, and coders on documentation, coding changes, compliance Issues
- Advises and participates in VBS clinical quality, data analytics and RCM strategic initiatives
- Assists in the development and maintenance of coding educational tools
- Monitors changes in laws, regulations, rules, and code assignments that impact documentation and reimbursement.
- Performs other duties as assigned
Skills, Abilities, and Requirements
- Experience ICD-10 coding with strong attention to detail and high accuracy rate
- In-depth knowledge of medical terminology, anatomy, physiology, and disease process
- Expertise in Medicaid and or Medicare risk adjustment models, HCC Coding required
- Working knowledge of health plan/insurance terminology and concepts
- Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint)
- Strong organizational and prioritization skills
- Excellent oral and written communication skills adaptable to individuals with varied levels of understanding at all levels of the organization
- Highly developed problem solving and deductive reasoning skills
- Must be able to handle multiple tasks at the same time and work well independently
Qualifications
Education: Associate’s degree in nursing required; bachelor’s degree in nursing preferred.
Licensure: Current RN license in good standing required.
Experience:
5+ years of clinical experience, preferably in an FQHC primary care setting.
3+ years of experience in Medicare/Medicaid risk adjustment (HHS-HCC, CMS-HCC, or DxCG methodologies).
Certifications:
Certified Risk Coder (CRC) through AAPC or CDI/CCS certification through AHIMA required.
Certified Professional Coder (CPC) through AAPC preferre
What We Offer
Competitive salary and comprehensive benefits package
100% employer-paid medical plan (including dependents on select plans)
Retirement Plan with employer match
Generous Paid Time Off (PTO) and Paid Holidays
Mission-driven culture dedicated to improving community health outcomes