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

📋 Description

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

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

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

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

• Manage and track work queues, review inventories, and activities related to OPAs.

• Ensure timely follow-ups, meet productivity goals, and accurately complete CDI interventions.

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

• Identify opportunities for improvement and support 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 required.

• CCDS, CCDS-O, CDIP, CDEO, and/or CRC certifications are highly preferred.

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

• Strong knowledge of ICD-10-CM coding guidelines and the requirements for HCC documentation and coding.

• Comprehensive understanding 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 tools (such as MS Teams, Zoom, etc.).