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

📋 Description

• Drive enhancements in the overall quality and completeness of Clinical Intelligence's recapture and suspecting performance.

• Analyze patient records to pinpoint and confirm Hierarchical Condition Category (HCC) diagnoses.

• Interact with providers to ensure precise and comprehensive documentation supporting HCC and condition-related diagnoses.

• Improve RAF score precision and boost risk adjustment outcomes.

• Utilize knowledge of medical terminology, disease processes, treatment modalities, diagnostic tests, medications, and procedures to identify documentation deficiencies.

• Confirm recapture and suspect conditions based on clinical evidence.

• Ensure that documentation substantiates reported conditions.

• Develop queries that reflect best practices.

• Generate recommendations aimed at enhancing clinical logic and workflows.

• Uphold strict confidentiality of patient information in line with privacy regulations.

⛳️ Requirements

• Graduate from an accredited nursing education program.

• Possess an active and unrestricted Registered Nurse or Advanced Practice Provider license.

• Hold certifications as a Certified Documentation Expert-Outpatient (CDEO), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), or Certified Documentation Improvement Practitioner (CDIP) along with Certified Risk Adjustment Coder (CRC).

• Have a minimum of 2 years of outpatient CDI experience.

• Experience in navigating Epic, Athena, and Cerner EMRs.

• A total of 5 years of clinical experience.

• Strong comprehension of CMS, HHS, Medicaid, and Rx HCC models.

• Knowledgeable about current industry standards related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines.

• Proficient in the utilization of electronic medical records and technology-driven solutions.

• Bachelor's Degree in Nursing is preferred.

• Ambulatory clinical experience is preferred.

• Must fulfill E-Verify requirements for new hires.