Clinical Risk Adjustment Documentation Specialist

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

📋 Description

• Act as a subject matter expert in the realm of clinical documentation quality, risk adjustment, and HCC coding integrity within outpatient environments.

• Conduct prospective evaluations of medical records from physician practices, outpatient facilities, and pertinent inpatient encounters.

• Confirm chronic conditions and guarantee the accuracy of documentation, clinical integrity, proper coding, and HCC capture.

• Utilize Epic and OurPractice Advisories (OPAs) to carry out prospective chart reviews and pinpoint documentation enhancement opportunities.

• Oversee and manage work queues, review inventories, and activities related to OPAs.

• Ensure prompt follow-up, meet productivity targets, and accurately complete CDI interventions.

• Monitor, assess, and report on CDI outcomes, documentation trends, and HCC recapture performance.

• Recognize improvement opportunities and assist in achieving program objectives.

⛳️ Requirements

• At least 2 years of experience in ambulatory Clinical Documentation Integrity, Risk Adjustment, or a related healthcare documentation field.

• An active LPN or RN license is mandatory.

• CCDS, CCDS-O, CDIP, CDEO, and/or CRC certification is highly preferred.

• Proficiency in Epic workflows, including the interpretation and management of OurPractice Advisories (OPAs) is preferred.

• A solid understanding of ICD-10-CM coding guidelines along with HCC documentation and coding requirements.

• Strong comprehension of clinical criteria for HCC diagnoses.

• Exceptional communication, critical thinking, and organizational abilities.

• Proficient in using MS Office, email, VPNs, virtual machines, two-factor authentication, and video conferencing platforms (MS Teams, Zoom, etc.).

🏝️ Benefits

• Comprehensive benefits package.

• Paid Time Off (PTO).

• Competitive salary.

• A collaborative, mission-driven team environment.

• Opportunities for ongoing learning, education, and professional development.

• Leadership that appreciates your expertise and input.