Ambulatory Clinical Documentation Integrity Specialist (Remote)

About the Role

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Applies data, research analysis, critical thinking, and problem-solving skills to support colleagues and leadership in achieving the organization’s strategic objectives. Serves as a peer influencer and may direct projects or project teams by leveraging industry experience and specialized knowledge.

Responsibilities

• Researches, collects, and analyzes information to identify opportunities, develop solutions, and lead through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency and patient experience.
• Responsible for the distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports, and develop educational materials.
• Incorporates knowledge of Trinity Health policies, practices, and processes to ensure quality, confidentiality, and safety.
• Researches and compiles information to support ad-hoc operational projects and initiatives.
• Synthesizes and analyzes data, providing detailed summaries, graphical presentations, and practical recommendations to support leadership decision-making.
• Leverages program and operational data to define and demonstrate progress, ROI, and impacts.
• Maintains working knowledge of applicable federal, state, and local laws, Trinity Health’s Integrity and Compliance Program, and Code of Conduct.
• Obtains appropriate clinical documentation through interaction with providers and coding staff to ensure documentation reflects the level of service rendered.
• Validates accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians and advanced practice providers.
• Conducts thorough prospective and retrospective quality reviews of ambulatory patient records, documenting findings and tracking key information.
• Identifies areas where documentation requires clarification and engages with healthcare professionals to resolve discrepancies.
• Ensures medical record documentation is accurate, complete, and compliant, supporting acute or chronic conditions and medical necessity.
• Applies understanding of payment structures, outpatient reimbursement models, and the impact of provider documentation and HCC risk adjustment.
• Identifies patterns and trends impacting documentation and coding, acting as a technical resource for documentation, coding, and billing regulations.

Requirements

• Associate’s degree in Business, Healthcare, Nursing, or related field, or equivalent combination of education and experience.
• Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, integrated healthcare delivery system, revenue cycle, or consulting.
• Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI), Certified Clinical Documentation Specialist – Outpatient (CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Integrity Practitioner (CDIP) credential with coding or clinical documentation integrity experience.

Additional Qualifications

• Bachelor’s degree in Nursing, Health Information Management (HIM), or related healthcare field (nice to have).

Physical and Mental Requirements

• General Summary:
  • Exposure to unpleasant conditions (sight, touch, sound, smell) and occasional exposure to fumes, odors, dusts, mists, gases, biohazards, mechanical/electrical hazards, chemicals, radiation, or sharp objects.
  • Occasional exposure to noise, infectious waste, diseases, interruptions, shifting priorities, and stressful situations.
  • Frequent ability to follow tasks through to completion, understand complex ideas, remember multiple tasks, and work on concurrent projects.
  • Frequent ability to read small print, hear sounds, and communicate verbally with some background noise.
  • Occasional manual dexterity activities, grasping, climbing, kneeling, crouching, or operating foot controls.
  • Frequent use of a computer or other technology.
  • Continuous ability to sit, vary physical position, maintain a safe working environment, use PPE, and comply with policies and procedures.
  • Occasional ability to provide assistance in emergencies.
• Direct Healthcare Services:
  • Frequent standing/walking with the ability to vary physical position.
  • Occasional lifting of up to 30 pounds unassisted and use of upper/lower extremities for bending, stooping, reaching, pushing, or pulling.
  • Occasional performance of physical efforts (e.g., transporting or moving patients).
  • Continuous work indoors under temperature-controlled and well-lit conditions.
  • Occasional encounter with variable environmental conditions at worksites (e.g., patient homes).
• Indirect Healthcare/Support Services:
  • Occasional standing/walking with the ability to vary physical position.
  • Occasional lifting of up to 30 pounds unassisted.
  • Occasional long periods of walking, standing, stooping, bending, pulling, or pushing.
  • Occasional encounter with clinical or patient-facing work environments.
  • Continuous work indoors under temperature-controlled and well-lit conditions.
  • Occasional work outdoors with variable external environmental conditions.

Average Workday Activity: Occasional (1% - 33%), Frequent (34% - 66%), Continuous (67% - 100%)

Pay

Pay grade 13 range: $75,592.71 – $113,389.06. Actual compensation will fall within this range and may vary based on factors such as experience, qualifications, education, location, licensure, certification, and comparisons to colleagues in similar roles.