Documentation Integrity and Coding Compliance Specialist

Analyze clinical documentation for completeness, coding accuracy, coding compliance, and risk adjustment documentation integrity Facilitate documentation modifications and clarification to support accurate hospital, physician, professional, and value-based billing and reporting Work with physicians and advanced practice providers to ensure diagnoses, services, and procedures accurately reflect services provided Serve as an expert coding, documentation, compliance, and risk adjustment resource for coding, CDI, quality, revenue cycle, and operational teams Perform initial, concurrent, retrospective, and follow-up medical record reviews Evaluate ICD-10-CM, CPT, HCPCS, CMS-HCC capture, documentation consistency and specificity, coding accuracy, and regulatory compliance Document findings in audit, CDI, coding, and reporting tools and verify key documentation and coding information Interpret clinical information, diagnoses, medications, treatment plans, test results, payer requirements, and regulatory requirements to improve documentation Identify documentation improvement opportunities and collaborate with medical staff, advanced practice providers, coding, CDI, revenue cycle, and quality teams Communicate with providers to obtain or offer more specific documentation of diagnoses, comorbidities, complications, HCC conditions, clinical indicators, and services rendered Collaborate with coding staff on coding guidelines, tracking information, service profiling and reporting, data review, and physician education Develop and present audit findings, trends, recommendations, education, and performance information to administrative, clinical, operational, compliance, provider, and committee stakeholders Support clinical denials, payer audits, risk adjustment validation, regulatory reviews, denial prevention, audit defense preparation, written responses, and appeals Demonstrate commitment to Bronson program goals, vision, values, and mission Requirements Bachelor’s degree required; Master’s degree preferred Experience in clinical documentation integrity, coding compliance, risk adjustment, provider education, revenue cycle, medical record auditing, or related healthcare operations required Strong knowledge of ICD-10-CM, CPT, HCPCS, CMS-HCC methodology, coding guidelines, documentation requirements, reimbursement methodologies, and regulatory compliance standards required Required certifications: CRC – Certified Risk Adjustment Coder and CPC – Certified Professional Coder CDEO – Certified Documentation Expert Outpatient strongly preferred at hire and required within twelve months of employment CVBA – Certified Value-Based Associate recommended/preferred but not required RN may be required for certain departments; RN license is not required for this position Exceptional communication and interpersonal skills Self-directed and flexible Leadership abilities and collaboration skills Strong analytical skills and advanced problem-solving ability Knowledge of Bronson / Community systems related to assigned service line or area of responsibility Ability to attend to detail while maintaining awareness of overall goals, compliance priorities, and operational impact Ability to function effectively in a fluid, dynamic, rapidly changing environment Prefer experience with risk adjustment strategy, RAF optimization, CMS-HCC documentation, audit defense preparation, coding quality audits, and value-based care models Core Competencies Demonstrates expertise in clinical documentation integrity, coding compliance, and risk adjustment, with a strong focus on ICD-10-CM, CPT, and HCPCS methodologies. Capable of collaborating with healthcare providers and teams to enhance documentation accuracy and support revenue cycle operations. Highest-signal resume keywords ICD-10-CM Coding CPT Coding HCPCS Coding Certified Risk Adjustment Coder (CRC) Certified Professional Coder (CPC) ATS Optimization Keywords Hard Skills Clinical Documentation Integrity Coding Compliance Risk Adjustment Medical Record Auditing Documentation Requirements Reimbursement Methodologies Regulatory Compliance Standards Audit Defense Preparation Data Review Provider Education Soft Skills Exceptional Communication Skills Interpersonal Skills Leadership Abilities Collaboration Skills Analytical Skills Certifications & Qualifications Certified Risk Adjustment Coder (CRC) Certified Professional Coder (CPC) Certified Documentation Expert Outpatient (CDEO) Certified Value-Based Associate (CVBA) Industry Keywords Revenue Cycle Value-Based Care Models CMS-HCC Methodology Audit Defense Risk Adjustment Strategy Tools & Technologies CDI Tools Coding Tools Reporting Tools #J-18808-Ljbffr Jobtailor