The Clinical Documentation Improvement Specialist is responsible for facilitating the improved quality, accuracy, and completeness of medical record documentation. This position will implement proactive measures to improve data quality, appropriate risk stratification of HCN’s VBS population, and overall improvement in quality of care.
- Serves as a subject matter expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and Risk Adjustment guidance
- Conducts proactive review of the medical record documentation including diagnosis coding, identification of co-morbidities and complications, and all appropriate secondary diagnoses
- Identifies issues and trends in coding and documentation that affect patient risk scores
- Works collaboratively with contracted health plans on risk adjustment initiatives; participates in auditing requests, reviews and assesses health plan results, and designs performance improvement plans as needed
- Develops and delivers provider and coder training, detailing coding best practices and provider level opportunities for improvement
- Provides education to providers, supporting clinical care teams, and coders on documentation, coding changes, compliance Issues
- Advises and participates in VBS clinical quality, data analytics, and RCM strategic initiatives
- Assists in the development and maintenance of coding educational tools
- Monitors changes in laws, regulations, rules, and code assignments that impact documentation and reimbursement;
- Performs other duties as assigned
Skills. Abilities and Requirements
- Experience ICD-10 coding with strong attention to detail and a high accuracy rate
- In-depth knowledge of medical terminology, anatomy, physiology, and disease process
- Expertise in Medicaid and or Medicare risk adjustment models, HCC Coding required
- Working knowledge of health plan/insurance terminology and concepts
- Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint)
- Strong organizational and prioritization skills
- Excellent oral and written communication skills adaptable to individuals with varying levels of understanding at all levels of the organization
- Highly developed problem solving and deductive reasoning skills
- Must be able to handle multiple tasks at the same time and work well independently
Health Choice Network is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations, and executive orders regarding affirmative action requirements in all programs.
HCN is a drug-free workplace.