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 guidance, and Risk Adjustment methodologies.

• Perform proactive reviews of medical records to assess the quality of documentation, accuracy of diagnosis coding, co-morbidities, complications, and relevant secondary diagnoses.

• Ensure accurate documentation and coding of patient conditions 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 guidance on best practices for documentation, coding updates, compliance requirements, and principles of risk adjustment.

• Develop educational tools, resources, and training materials.

• Collaborate with providers to discover opportunities for documentation improvement and workflow optimization.

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

• Assist with auditing processes, review findings from health plans, and create performance improvement plans as necessary.

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

• Monitor changes in regulations, coding, and reimbursement, and communicate the effects across the organization.

• Analyze trends in documentation and coding to pinpoint improvement opportunities.

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

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

⛳️ Requirements

• Associate degree required; Bachelor's degree preferred.

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

• A minimum of 3 years of experience in Medicare and/or Medicaid Risk Adjustment, including methodologies such as HHS-HCC, CMS-HCC, or DxCG.

• Robust experience with ICD-10 coding and clinical documentation review.

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

• Proficiency in HCC coding and risk adjustment programs.

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

• Exceptional written and verbal communication skills, capable of educating audiences at all levels.

• Capability to manage multiple priorities and operate independently in a remote setting.

• Current RN license in good standing (preferred).

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

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

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

• Experience supporting value-based care and population health initiatives (preferred).

• Applicants must reside and work in an approved state at the time of hire and throughout their employment.

• Health Choice Network is unable to employ individuals who reside or work in California.

🏝️ Benefits

• 100% Remote Work – Enjoy the flexibility to work from anywhere within the United States.

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

• Generous Paid Time Off (PTO).

• 403(b) Retirement Plan with Employer Contribution.

• Professional Development & Education Assistance – Opportunities for ongoing learning, certifications, and educational pursuits.

• Mission-Driven Culture focused on enhancing community health and expanding access to quality healthcare services.