Clinical Document Improvement Specialist

Job Description Summary

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Job Description: Candidate must reside in the Los Angeles region. This is a hybrid position that requires regular travel within the LA/OC area.”
Responsible for collection and assessment of claim/encounter information as it pertains to CMS guidelines. Primary duties may include but are not limited to:
· Leads Risk Adjustment operations including provider education, data analysis, audits and overseeing record request process.
· Oversees day to day operations.
· Ensures compliance with mandated and corporate policies.

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How will you make an impact & Requirements

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Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. Primary duties include, but are not limited to:

• Conducts prospective, concurrent, and retrospective medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures.
• Verifies accuracy/appropriateness of submitted diagnosis codes based on medical record documentation looking at 1) appropriate detail in the medical record is not captured in what is reported, and 2) when reported information is not supported by details in the medical record.
• Identifies and educates on compliant documentation and coding best practices to address unsupported additions/deletions, inconsistencies/discrepancies.
• Updates and develops policies and procedures and training/educating material to reflect best practices.
• Conducts ongoing review, monitoring and communications with assigned clinicians to promote and ensure adherence to established protocols and best practices.
• Reviews documentation of well visits (annual well visits and other routine and preventative visits).
• Conducts on-going review of encounter notes to monitor performance improvement and identify new opportunities for education and training.

Requires BA/BS in health care or business and minimum of 2 years’ experience in healthcare industry and expertise in Risk Adjustment; or any combination of education and experience, which would provide an equivalent background. AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) coding certification or equivalent certification required.

Preferred Qualifications:

• 2 years experience coding all types of medical records (including Medicare Risk Adjustment) in a physician practice setting or large group practice.
• Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO) strongly preferred
• Current Certified Professional Coder certification (CPC, CPC-H, CRC, CCS, or CCS-P)
• Additional experience in procedural clinical coding preferred.
• Clinical experience or background (e.g., RN, LPN, foreign medical graduates).

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Compensation Range:

$97,790.00

to

$146,686.00

 

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.