Clinical Documentation Improvement, CDI Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine paper-based medical records to verify the accuracy of HCC coding and support encounter submissions.

• Oversee daily compliance activities for providers associated with Concerto Medicare membership.

• Administer the Clinical Documentation Initiative process for risk adjustment providers.

• Instruct providers on the importance of diagnosis specificity and proper clinical documentation.

• Create, present, and distribute communications for providers.

• Ensure adherence to CMS Risk Adjustment HCC methodology rules, regulations, coding, and documentation standards.

• Assist in the development and execution of a CDI risk adjustment and provider outreach program for ConcertoCare provider groups and payer partnerships.

• Coordinate with risk adjustment vendors regarding medical record reviews, provider alert compliance, and provider education.

• Supervise assigned providers and markets, managing monthly educational and engagement sessions for providers.

• Identify areas for improvement and oversee the clinical documentation provider engagement model.

• Conduct chart reviews and evaluate provider activities regarding HCC conditions.

• Generate documentation queries that require enhancement and engage with providers to capture the severity of patient illnesses.

• Assist in creating resources for provider education focused on documentation accuracy.

• Communicate effectively with team members, leadership, and internal departments to resolve issues and concerns.

⛳️ Requirements

• A current coding certification is required: CRC, CPC, CCS, CPC-H, or CCS-P; CPC-A is not acceptable.

• A high school diploma is required.

• A Bachelor's degree in Healthcare, Finance, or Business is preferred.

• Extensive knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

• In-depth knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding.

• Familiarity with regulatory requirements, coding, and compliance standards.

• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.

• Strong writing and grammar skills, including formatting reports and correspondence, spelling, word usage, grammar, punctuation, and sentence structure.

• Ability to type and use software to create correspondence, charts, spreadsheets, and other relevant information.

• An analytical problem-solving mindset with a focus on practical, results-driven outcomes.

• Capability to manage multiple priorities while maintaining a positive demeanor.

• Unquestionable integrity and professionalism.

🏝️ Benefits

• Annual bonus

• Full healthcare coverage

• 401K with match

• Additional health, wellness, and financial benefits

• Alcohol/Drug/Smoke-Free Workplace