Clinical Documentation Improvement (CDI) Specialist

Clinical Documentation Improvement Specialist

Under the direction of the Manager of Clinical Documentation Improvement, this position will be responsible for reviewing paper based medical charts to ensure accuracy of HCC coding captured and the encounter submission is substantiated in the member's medical chart. Manage the day-to-day activities involving the provider compliance functions for Concerto Medicare membership. This will include but is not limited to managing the risk adjustment provider Clinical Documentation Initiative process, educating providers on the importance of dx specificity; developing, presenting, and disseminating provider communications, and other activities related to clinical documentation.

Responsibilities

• Ensure compliance with all applicable CMS Risk Adjustment Hierarchical condition category (HCC) Methodology rules and regulations related to coding and documentation guidelines for Risk Adjustment.
• Responsible for supporting the development and implementation of a comprehensive Clinical Documentation Improvement (CDI) risk adjustment and provider outreach program to support all ConcertoCare provider groups & payor partnerships.
• Serve as a liaison between ConcertoCare and Risk Adjustment vendors for efforts related to the Medical Record Review process: provider alert compliance activity; and provider education on proper coding and documentation.
• Oversee assigned providers and markets while being responsible for provider education/engagement monthly. Identifying areas for improvement and routinely monitoring success of the clinical documentation provider engagement model. Perform chart review and analysis of provider activity around HCC conditions documented at date of service, query generation for documentation requiring improvement
• Review for clinical indicators and query providers to capture the severity of illness of the patient.
• Assists in the development tools for provider education on documentation accuracy.
• Communicate effectively with team, leadership, and internal departments as necessary to address issues and concerns.

Qualifications

• Current coding certification to include one of the following: CRC, CPC, CCS, CPC-H, and CCS-P (no CPC-As for this role) required.
• High school diploma required; Bachelors Degree in Healthcare, Finance or Business preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes and pharmacology.
• Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding, medical terminology and regulatory requirements are required.
• Proficient in the Microsoft Office Suite, Coding and compliance standards.
• Fundamental principles of writing and grammar, including proper report and correspondence format, correct spelling and proper word usage, grammar, punctuation, and sentence structure.
• Keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment required.
• Orientation toward analytical problem solving with practical, results-oriented mindset.
• Ability to manage multiple priorities while maintaining a positive attitude.
• Unimpeachable integrity and maturity.
• Strong computer experience in MS Word, Excel and Outlook.

Base Salary/ Wage Range $70,000 to $80,000 plus annual bonus. Compensation for the role is commensurate with the candidate's qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace.