Clinical Documentation Specialist – Outpatient

Job Description:

• Facilitate improvement in the overall quality and completeness of Clinical Intelligence’s recapture and suspecting performance
• Review patient records to identify and validate Hierarchical Condition Category (HCC) diagnoses
• Query providers to ensure accurate and complete documentation supporting HCC and condition-related diagnoses
• Enhance RAF score accuracy and improve risk adjustment outcomes
• Apply medical terminology, disease process, treatment modality, diagnostic test, medication, and procedure knowledge to identify documentation gaps
• Validate recapture and suspect conditions based on clinical evidence
• Validate that documentation supports reported conditions
• Create queries reflecting best practice
• Formulate recommendations to improve clinical logic and workflows
• Maintain strict confidentiality of patient information in accordance with privacy regulations

Requirements:

• Graduate of an accredited nursing education program
• Active and unrestricted Registered Nurse or Advanced Practice Provider license
• Certified Documentation Expert-Outpatient (CDEO) or Certified Clinical Documentation Specialist- Outpatient (CCDS-O) or Certified Documentation Improvement Practitioner (CDIP) and Certified Risk Adjustment Coder (CRC)
• Minimum of 2 years outpatient CDI experience
• Experience navigating Epic, Athena, and Cerner EMRs
• 5 years of clinical experience
• Strong understanding of CMS, HHS, Medicaid, and Rx HCC models
• Up to date with industry standards related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines
• Proficient in the use of electronic medical records and technology enabling solutions
• Bachelor’s Degree in Nursing preferred
• Ambulatory clinical experience preferred
• Must complete E-Verify requirements for new hires

Benefits:

• Competitive salary
• Medical, Dental and Vision benefits
• 401k match
• Generous PTO plan