Clinical Documentation Integrity Specialist, Bilingual in Spanish/English

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

📋 Description

• Evaluate clinical documentation to ensure coding is accurate, complete, and compliant according to ICD-10-CM, HCC, and regulatory standards.

• Act as the subject matter expert on outpatient risk adjustment documentation and HCC coding regulations.

• Perform Clinical Documentation Integrity (CDI) reviews and Quality assessments to guarantee precise capture of quality measures and risk adjustment information.

• Request documentation clarifications from providers while ensuring adherence to coding and documentation standards.

• Examine documentation trends and pinpoint opportunities for provider education, workflow enhancements, and operational optimization.

• Create and deliver ongoing education and training sessions to providers regarding documentation best practices and coding standards.

• Foster strong collaborative relationships with providers and cross-functional teams throughout the organization.

• Aid leadership in analyzing, trending, reporting, and presenting audit findings and opportunities for documentation improvement.

• Review and interpret medical records in Spanish to ensure accurate ICD-10 and CPT coding.

• Effectively communicate in both Spanish and English with providers and care team members concerning documentation inquiries and coding guidance.

• Identify documentation trends within Spanish-language records and relay findings to stakeholders to enhance coding accuracy and risk capture.

• Support bilingual care teams by translating or clarifying documentation-related concepts while upholding compliance standards.

• Provide documentation guidance to Spanish-speaking frontline Care Navigators as required.

• Assist in translating documentation education and training materials for Spanish-speaking providers and care teams.

• Uphold the confidentiality of patient information and comply with all company policies and compliance regulations.

• Contribute to Duo Health's ongoing quality improvement initiatives.

⛳️ Requirements

• At least 5 years of Clinical Documentation Integrity (CDI) and Quality experience.

• A minimum of 3 years of outpatient risk adjustment CDI experience.

• Proficiency in both spoken and written Spanish and English is essential.

• Capability to read, interpret, and analyze clinical documentation written in Spanish.

• Ability to communicate effectively with clinicians and internal teams in both English and Spanish.

• Strong understanding of ICD-10-CM coding, HCC risk adjustment methodology, medical terminology, disease processes, pharmacology, and clinical documentation standards.

• Experience in independently managing projects and driving documentation improvement initiatives.

• A bachelor's degree in nursing is preferred; equivalent education and experience will be taken into account.

• CCS, CRC, CPC, CCDS, or CDIP certification is preferred.

• Excellent analytical, organizational, and critical thinking abilities with a keen attention to detail.

• Comfortable working independently in a fast-paced, remote environment.

• Outstanding written and verbal communication skills.

• Ability to cultivate strong working relationships and collaborate effectively in a virtual setting.

🏝️ Benefits

• Competitive medical, dental, and vision plans.

• Paid maternity and paternity leave.

• Adoption Assistance.

• Access to complimentary wellness and personal development courses.

• 401(k) plan with company matching.

• 12 Paid holidays.