Ambulatory CDI Specialist

We need to output HTML fragment with sections: About the role? The posting includes description about Lexington Health (company overview) and Job Summary. We need to use

for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We should only include sections that have real specific content. We have: - About the role: Could be the Job Summary and description of role. That is substantive. - Responsibilities: The "Essential Functions" and "Duties & Responsibilities" sections. - Requirements: Minimum Qualifications, Required Certifications/Licensure, etc. - Qualifications: maybe same as Requirements? But we can combine. - Skills: Not explicitly listed but could be implied from duties (communication, prioritization, etc). Might be better to not create a Skills section unless explicit. - Benefits: The paragraph about benefits (Day ONE medical, dental, life insurance, FSAs, 403(b) match, employer paid life insurance, supplemental life, adoption assistance, disability coverage, tuition reimbursement, student loan forgiveness). That's specific. - Pay: Not mentioned. No pay info. So we should NOT include Pay section. - Schedule: The posting says "ACO Full Time Day Shift 0800-1630". That's schedule info. So we can include Schedule section with that. We must not repeat job title as heading. The job title is "ACO Full Time Day Shift 0800-1630"? Actually the title maybe "ACO Full Time Day Shift 0800-1630"? The posting starts with that line. We should not repeat it. We need to preserve all substantive information, not invent or summarize away detail. Must not include boilerplate like EEO, etc. Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The posting includes an Equal Opportunity Employer paragraph at end; we must remove that. Also "Nearest Major Market: Columbia Nearest Secondary Market: South Carolina" maybe considered metadata; could be folded into a short p or dropped. Probably we can include as a short p under About the role? But it's not essential; we could drop as minor metadata. The instruction: "do NOT put Job ID / requisition numbers as headings — fold minor metadata into a short

or drop it." So we can drop that line. We need to output only HTML fragment, no /, no markdown fences. Let's structure:

About the role

... company overview and job summary ...

Responsibilities

• ... each duty ...

We need to capture all duties from Essential Functions and Duties & Responsibilities. Essential Functions list: - Validate the accurate assignment of working HCC diagnoses affecting RAF scores within the ambulatory patient population by collaborating with physicians and advanced practice providers. - Conduct thorough prospective reviews of selected ambulatory patient records, documenting all relevant findings and tracking key information throughout the process. - Identify areas where documentation requires clarification and engage with physicians, advanced practice providers, and other healthcare professionals to resolve discrepancies. - Maintain strict confidentiality of patient information and hospital and physician practice data in accordance with privacy regulations. - Assure all documentation is accurate, complete, and compliant, supporting acute or chronic conditions and medical necessity. This helps improve patient outcomes and supports risk adjustment needs. - Develop and sustain positive working relationships with providers, advanced practice providers, administrators, and revenue cycle partners to promote the success of the CDI program. Duties & Responsibilities list: - Use strong communication skills to connect CDI workflow and processes, driving results through the ambulatory CDI program. - Understanding of payment structures, outpatient reimbursement models, and the impact of provider documentation on ICD-10-CM and HCC risk adjustment, ensuring compliance with reporting standards for claims submission. - Develop presentations for providers individually and in groups to understand the importance of CDI and requirements within the outpatient clinic settings. - Able to effectively prioritize tasks such as documentation reviews, provider education, and program deadlines. - Stay up to date with industry standards by participating in internal and external continuing education related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines. - Utilize software and other technology tools to prioritize tasks, collect and analyze data, and monitor program effectiveness and outcome reporting. - Perform other duties as assigned. We should combine them into a single list under Responsibilities, preserving all. Now Requirements/Qualifications: Minimum Qualifications: - Minimum Education: Associate's Degree in Nursing - Minimum Years of Experience: A minimum of 3 years clinical experience in nursing. Preferred experience includes CDI, coding, or risk adjustment experience in ambulatory or acute care setting. - Substitutable Education & Experience: None. - Required Certifications/Licensure: Current Registered Nurse (RN) License; Certification from either AAPC (Certified Documentation Expert - Outpatient (CDEO) or Certified Risk Adjustment Coder (CRC)) or ACDIS (Certified Clinical Documentation Specialist-Outpatient (CCDS-O)) or AHIMA (Certified Coding Specialist (CCS) or Certified Documentation Improvement Practitioner (CDIP)). Those without one of the listed certifications must obtain one of the listed certifications within 2 Years of entry into the role. - Required Training: None. We could put these under Requirements heading. We could also have Qualifications heading but maybe combine. We need to avoid duplicate content. We'll put Requirements. Now Benefits: We have a paragraph describing benefits. We'll put under Benefits heading. Schedule: We have "ACO Full Time Day Shift 0800-1630". So schedule: Full Time Day Shift 0800-1630. We'll put under Schedule heading. Now About the role: Should include company overview and Job Summary. Company overview: "Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer. Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship." Job Summary: "The Ambulatory Clinical Documentation Integrity (CDI) Specialist is responsible for conducting comprehensive prospective and retrospective reconciliation reviews of ambulatory medical records to identify and capture documented and potential Hierarchical Condition Category (HCC) diagnoses and autosuggested conditions impacting HCC coding and Risk Adjustment Factor (RAF) scores. The specialist will query providers to ensure accurate and complete documentation that supports HCC and condition-related diagnoses, ultimately enhancing RAF score accuracy and improving risk adjustment outcomes. In this role, the CDI Specialist is responsible for facilitating improvement in the overall quality and completeness of medical record documentation on a prospective basis. The CDI Specialist promotes modifications to medical record documentation to ensure accurate depiction of the level of clinical services provided to the patient and to completely describe patients’ severity of illness. The CDI Specialist obtains appropriate clinical documentation through collaborative communications from having developed positive working relationships with physicians, nursing staff, other patient care providers, and the coders. The CDI Specialist is also responsible for providing informal and formal education to all members of the care team regarding clinical documentation." We'll combine into a paragraph or multiple paragraphs? Use

for prose. Could be two paragraphs: one for company overview, one for job summary. Now we must not include EEO paragraph. Also remove "Nearest Major Market: Columbia Nearest Secondary Market: South Carolina". We'll drop. Now ensure we don't include any headings with empty content. Now produce HTML. Let's craft:

About the role

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer. Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

The Ambulatory Clinical Documentation Integrity (CDI) Specialist is responsible for conducting comprehensive prospective and retrospective reconciliation reviews of ambulatory medical records to identify and capture documented and potential Hierarchical Condition Category (HCC) diagnoses and autosuggested conditions impacting HCC coding and Risk Adjustment Factor (RAF) scores. The specialist will query providers to ensure accurate and complete documentation that supports HCC and condition-related diagnoses, ultimately enhancing RAF score accuracy and improving risk adjustment outcomes. In this role, the CDI Specialist is responsible for facilitating improvement in the overall quality and completeness of medical record documentation on a prospective basis. The CDI Specialist promotes modifications to medical record documentation to ensure accurate depiction of the level of clinical services provided to the patient and to completely describe patients’ severity of illness. The CDI Specialist obtains appropriate clinical documentation through collaborative communications from having developed positive working relationships with physicians, nursing staff, other patient care providers, and the coders. The CDI Specialist is also responsible for providing informal and formal education to all members of the care team regarding clinical documentation.

Responsibilities

• Validate the accurate assignment of working HCC diagnoses affecting RAF scores within the ambulatory patient population by collaborating with physicians and advanced practice providers.
• Conduct thorough prospective reviews of selected ambulatory patient records, documenting all relevant findings and tracking key information throughout the process.
• Identify areas where documentation requires clarification and engage with physicians, advanced practice providers, and other healthcare professionals to resolve discrepancies.
• Maintain strict confidentiality of patient information and hospital and physician practice data in accordance with privacy regulations.
• Assure all documentation is accurate, complete, and compliant, supporting acute or chronic conditions and medical necessity. This helps improve patient outcomes and supports risk adjustment needs.
• Develop and sustain positive working relationships with providers, advanced practice providers, administrators, and revenue cycle partners to promote the success of the CDI program.
• Use strong communication skills to connect CDI workflow and processes, driving results through the ambulatory CDI program.
• Understanding of payment structures, outpatient reimbursement models, and the impact of provider documentation on ICD-10-CM and HCC risk adjustment, ensuring compliance with reporting standards for claims submission.
• Develop presentations for providers individually and in groups to understand the importance of CDI and requirements within the outpatient clinic settings.
• Able to effectively prioritize tasks such as documentation reviews, provider education, and program deadlines.
• Stay up to date with industry standards by participating in internal and external continuing education related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines.
• Utilize software and other technology tools to prioritize tasks, collect and analyze data, and monitor program effectiveness and outcome reporting.
• Perform other duties as assigned.