Clinical Documentation Improvement Nurse – Certified

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

📋 Description

• Collaborate with stakeholders from health plans, delivery systems, and provider networks to establish and implement clinical documentation and coding procedures as well as best practices.

• Evaluate clinical documentation to support HEDIS and engage in HEDIS medical record abstraction.

• Provide recommendations aimed at enhancing clinical documentation and ensuring that coding accurately reflects the services reviewed.

• Verify the accuracy of diagnosis codes submitted to CMS.

• Educate providers and staff within the delivery system and provider network on quality and risk-adjustment documentation and reporting.

• Identify trends and develop action plans to enhance documentation accuracy and capture risk-adjustment codes.

• Assist with accreditation and regulatory compliance, ensuring that HEDIS requirements and quality audits are satisfied.

• Manage both internal and external relationships that support HEDIS and Risk Adjustment initiatives.

• Act as a subject matter expert in clinical risk-adjustment coding and assist in planning and executing coding initiatives.

• Research CMS and regulatory publications to create best-practice policies and educational materials for providers.

• Review clinical records to identify gaps or inaccuracies, formulate clarifications, and communicate with providers about diagnoses, ICD-10 codes, and necessary supporting documentation.

• Train providers, practice leadership, and designated staff on clinical documentation and risk-adjustment coding.

• Analyze population data and metrics to enhance coding outcomes.

• Identify discrepancies between existing and desired clinical operational frameworks.

• Create monitoring tools to track the successes and challenges of the CDI program and facilitate process enhancements.

• Perform other related duties as assigned.

⛳️ Requirements

• Bachelor’s Degree in Nursing is required.

• Current RN license in good standing is mandatory.

• A minimum of 5 years of clinical experience, preferably in geriatrics.

• At least 2 years of clinical coding experience is preferred.

• One or more certifications are required: CDI, CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, or CPMA.

• Ability to present and educate small and large groups effectively.

• Flexibility in scheduling and willingness to travel locally based on business needs.

• Familiarity with HEDIS and abstraction concepts is preferred.

• Knowledge of Medicare Risk Adjustment is preferred.

• Capacity to assess population health needs and outline health improvement priorities.

• Exceptional verbal and written communication skills are essential.

• Self-motivated and accountable for project management and follow-up.

• Strong organizational and planning capabilities are required.

• Ability to meet deadlines and produce precise work.

• Capability to manage multiple tasks simultaneously.

• Ability to work independently.

• Strong clinical knowledge with an understanding of Evidence-Based Practice principles.

• Ability to identify and educate on appropriate sources for standards of care.

• Proficiency in reviewing and analyzing population data and metrics.

• Ability to build and maintain effective relationships.

• Adaptability and flexibility in response to changing demands.

• Willingness to undertake additional tasks as assigned.

• Must not require immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Additional employee benefits.