Ambulatory Clinical Documentation Integrity Specialist (Remote)

Employment Type

Full time

Shift Description

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

Essential Functions

• Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
• Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
• Responsible for distribution of analytical reports.
• Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & procedures to ensure quality, confidentiality & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
• Researches, compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommends practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.
• Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Work Focus

• Obtain appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate.
• Validate the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers.
• Conduct thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process.
• Identify areas where documentation requires clarification & engage with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies.
• Ensure medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity.
• Apply through understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission.

Process Focus

• Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & procedures to ensure quality, confidentiality & safety are prioritized.
• Incorporates basic knowledge of Trinity Health policies, practices & procedures to ensure quality, confidentiality & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis

• Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommends practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Physical & Mental Requirements & Working Conditions

• Direct Healthcare Services / Indirect Healthcare / Support Services: Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. OccasionalExposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). OccasionalExposure to or subject to noise, infectious waste, diseases & conditions. OccasionalExposure to interruptions, shifting priorities & stressful situations.
• FrequentAbility to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. ContinuousAbility to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. FrequentPerform manual dexterity activities & / or grasping / handling. OccasionalAbility to climb, kneel, crouch & / or operate foot controls. OccasionalUse a computer / other technology. FrequentSit with the ability to vary / adjust physical position or activity. ContinuousMaintain a safe working environment & use available personal protective equipment (PPE). ContinuousComply with applicable Code of Conduct, policies, procedures & guidelines. ContinuousAbility to provide assistance in the event of an emergency. Occasional Direct Healthcare Services Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. FrequentLift a maximum of 30 pounds unassisted. OccasionalUse upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. OccasionalWork indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. ContinuousWork outdoors with variable external environmental conditions. Occasional Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

Pay

pay grade 13 range 75,592.7054-113,389.0581 Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.

Schedule

The schedule is not specified in the job posting.