Clinical Documentation Improvement Specialist

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

📋 Description

• Act as a subject matter expert on ICD-10-CM Coding Guidelines, AHA Coding Clinic recommendations, and methodologies for Risk Adjustment.

• Conduct thorough medical record assessments to review documentation quality, accuracy of diagnosis coding, co-morbidities, complications, and suitable secondary diagnoses.

• Ensure that patient conditions are accurately recorded and coded to facilitate quality care and proper risk stratification.

• Identify trends in documentation and coding that affect patient risk scores and performance in value-based care.

• Design and implement educational programs for providers, coders, and clinical care teams.

• Offer expertise on best practices in documentation, updates in coding, compliance requirements, and principles of risk adjustment.

• Develop educational tools, resources, and training materials.

• Collaborate with providers to pinpoint opportunities for documentation enhancement and workflow optimization.

• Work in partnership with contracted health plans on initiatives related to risk adjustment and value-based care.

• Assist with auditing activities, review findings from health plans, and formulate performance improvement strategies.

• Engage in clinical quality, revenue cycle, population health, and data analytics initiatives.

• Keep track of regulatory, coding, and reimbursement changes, communicating their effects throughout the organization.

• Analyze documentation and coding patterns to uncover opportunities for improvement.

• Collaborate closely with clinical leadership, coding teams, health plans, and operational stakeholders.

• Help implement strategies that enhance quality scores, risk adjustment accuracy, and overall organizational performance.

⛳️ Requirements

• Associate degree is required; a Bachelor's degree is preferred.

• Certified Risk Coder (CRC) through AAPC or CDI/CCS certification through AHIMA.

• At least 3 years of experience in Medicare and/or Medicaid Risk Adjustment, including HHS-HCC, CMS-HCC, or DxCG methodologies.

• Strong background in ICD-10 coding and clinical documentation review.

• Comprehensive knowledge of medical terminology, anatomy, physiology, and disease processes.

• Proficient in HCC coding and risk adjustment programs.

• Strong analytical, organizational, and problem-solving capabilities.

• Excellent written and verbal communication skills with the ability to educate diverse audiences.

• Ability to prioritize multiple tasks and work autonomously in a remote setting.

• Current RN license in good standing is preferred.

• Certified Professional Coder (CPC) through AAPC is preferred.

• Minimum of 3 years of clinical experience, ideally in a Federally Qualified Health Center (FQHC) or primary care setting.

• Experience with Epic Electronic Medical Record (EMR) systems is preferred.

• Background in supporting value-based care and population health initiatives is preferred.

🏝️ Benefits

• 100% Remote Work – Enjoy the flexibility of working from anywhere within the United States.

• 100% Employer-Paid Medical Insurance – Comprehensive medical coverage at no cost to employees on one of our health plans.

• Annual $1,500 HSA Contribution.

• Generous Paid Time Off (PTO).

• 403(b) Retirement Plan with Employer Contribution.

• Professional Development & Education Assistance.

• Mission-Driven Culture.