Clinical Documentation Improvement (CDI) Specialist

About the role

Under the direction of the Manager of Clinical Documentation Improvement, this position will review paper-based medical charts to ensure accuracy of HCC coding captured and that the encounter submission is substantiated in the member’s medical chart. The role manages the day-to-day activities involving provider compliance functions for Concerto Medicare membership, including the risk adjustment provider Clinical Documentation Initiative process, educating providers on diagnosis specificity, developing and disseminating provider communications, and other clinical documentation activities.

Responsibilities

• Ensure compliance with all applicable CMS Risk Adjustment Hierarchical Condition Category (HCC) Methodology rules and regulations related to coding and documentation guidelines for Risk Adjustment.
• Support the development and implementation of a comprehensive Clinical Documentation Improvement (CDI) risk adjustment and provider outreach program to support all ConcertoCare provider groups and payor partnerships.
• Serve as a liaison between ConcertoCare and Risk Adjustment vendors for efforts related to the Medical Record Review process, provider alert compliance activity, and provider education on proper coding and documentation.
• Oversee assigned providers and markets, including monthly provider education and engagement, identifying areas for improvement, and monitoring the success of the clinical documentation provider engagement model.
• Perform chart review and analysis of provider activity around HCC conditions documented at the date of service, generate queries for documentation requiring improvement, and review clinical indicators to capture the severity of illness of the patient.
• Assist in the development of tools for provider education on documentation accuracy.
• Communicate effectively with team members, leadership, and internal departments to address issues and concerns.

Requirements

• Current coding certification (CRC, CPC, CCS, CPC-H, or CCS-P required; no CPC-As).
• High school diploma required; Bachelor’s Degree in Healthcare, Finance, or Business preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
• Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding, as well as regulatory requirements.
• Proficiency in Microsoft Office Suite, coding, and compliance standards.
• Strong writing and grammar skills, including proper report and correspondence format.
• Ability to manage multiple priorities while maintaining a positive attitude.
• Analytical problem-solving skills with a practical, results-oriented mindset.
• Unimpeachable integrity and maturity.
• Strong computer experience in MS Word, Excel, and Outlook.

Pay

Base salary range: $70,000 to $80,000 plus annual bonus. Compensation is commensurate with the candidate’s qualifications, skills, competencies, and experience.

Benefits

• Competitive total rewards package, including full healthcare coverage.
• 401K with company match.
• Broad range of health, wellness, and financial benefits.