Clinical Documentation Improvement Specialist

4 weeks ago

South Portland, United States InterMed, P.A. Full time
Job DescriptionJob DescriptionState of Maine Residency is required.Essential Functions
  • Conducts prospective and retrospective review of the medical record to ensure accurate, complete, and specific documentation that reflects the current clinical complexity of the patient
  • Collaborates with Coding and Coding Education Staff to:
    • Provide education to Providers and support clinical care teams on documentation, coding changes, and compliance concerns
    • Monitor changes in laws, regulations, rules, and code assignments that impact documentation, reimbursement, and patient risk scores
    • Provide input and valuable feedback on audit results as applicable
  • Collaborates with interdisciplinary teams to assist with problem resolution, appropriate reimbursement, and systems/performance measures
  • Provides consultation and education to organizational departments and committees as requested to ensure regulatory compliance and optimum reimbursement
  • Develops relationships with providers and communicates guidelines and requirements of Risk Adjustment Payment System to ensure accurate coding and documentation
  • Maintains knowledge of related regulations and requirements supporting ACA/Commercial Risk Adjustment Data Validation
  • Completes and tracks all Patient Assessment Forms and other various projects as requested by health plans
Job Requirements
  • Current Maine RN license in good standing required
  • Associates degree in Nursing or higher required; Bachelor’s Degree in Nursing Preferred
  • Recent clinical experience (minimum 5 years), preferably in primary care setting
  • Experience with EMR, preferably eClinical Works
  • Certified Risk Adjustment Coder (CRC) or ability to obtain certification within 6 months from date of hire
  • 1+ years recent experience ICD-10 coding and/or 1+ years of recent Risk Adjustment / HCC Coding experience preferred
  • Knowledge of HEDIS, abstraction concepts, Medicare Risk Adjustment and CMS risk adjustment guidelines, health plan terminology and concepts preferred
  • Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint) required
  • The ideal candidate will: possess strong attention to detail, organizational and prioritization skills, and the ability to handle multiple tasks at the same time; flexibility and willingness to work both independently and collaboratively as part of a team; excellent oral and written communication skills, professional judgment and decision- making ability; highly developed problem solving and deductive reasoning skills; ability to meet deadlines and produce accurate work product.

InterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and/or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.

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