Remote Clinical Documentation Improvement Nurse - Certified

Join Martin's Point Health Care—an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Employees enjoy an organizational culture of trust and respect, where values—taking care of ourselves and others, continuous learning, helping each other, and having fun—are brought to life every day. Martin's Point has been certified as a "Great Place to Work" since 2015.

About the Role

As a member of the GA Programs team, the Clinical Documentation Improvement Nurse partners with key stakeholders within the health plan, delivery systems, and provider network to develop and implement processes and best practices supporting accurate diagnostic coding and attention to gaps in care related to Medicare Advantage Risk Adjustment. This role reviews clinical documentation to support HEDIS and participates in the HEDIS medical record abstraction process. The position assists the provider community in improving the overall accuracy, quality, and completeness of clinical documentation.

Responsibilities

• Facilitate recommendations for improvement to clinical documentation through interaction with key stakeholders in the delivery system and participating provider network to ensure accuracy of documentation and coding reflective of services rendered.
• Ensure the accuracy and completeness of clinical information used for measuring and reporting outcomes and confirm accuracy of diagnosis codes on submissions to the Centers for Medicare and Medicaid Services (CMS).
• Provide education related to quality and risk adjustment documentation and reporting in the delivery system and participating provider network.
• Identify trends, develop, and execute action plans to increase clinical documentation accuracy and capture of risk-adjustable codes.
• Support accreditation and regulatory compliance by evaluating process effectiveness, identifying and acting on improvement opportunities, and ensuring all HEDIS requirements are met.
• Ensure compliance for all HEDIS quality audits and maintain all data and process controls.
• Manage internal and external relationships to promote positive working relationships and advance HEDIS and Risk Adjustment clinical documentation and coding reporting initiatives.
• Serve as a risk adjustment coding subject matter expert from a clinical perspective and collaborate with the management team to strategically plan and execute risk adjustment coding efforts.
• Research and understand CMS and other regulatory and reputable risk adjustment publications to assist in developing best practice policies and creating educational materials, such as coding newsletters for providers.
• Review clinical records to ensure completeness and accuracy of clinical documentation, identify gaps or inaccuracies, formulate credible clarifications, and communicate with providers to clarify clinical diagnoses, ICD-10 code selections, and supporting documentation.
• Provide training to providers, practice leadership, and designated staff to facilitate accuracy of clinical documentation and risk adjustment coding and improve methodologies to support data integrity.
• Review clinical documentation to identify incomplete or inaccurate information for clinical relevance and work with key stakeholders to ensure points of clarification are recorded in medical records.
• Maintain knowledge of the Medicare Advantage program, its impact on payment, pathophysiology, disease processes, and value-based purchasing and other quality metrics affecting clinical documentation integrity.
• Review and analyze population data and metrics to inform improved coding outcomes.
• Identify gaps in clinical operational structure between current and desired states.
• Develop monitoring tools to track successes and challenges in the CDI program to facilitate process improvements.
• Perform all other related duties as assigned.

Requirements

• Bachelor’s Degree in Nursing required.
• Current RN license in good standing required.
• 5+ years of clinical experience, preferably in geriatrics.
• 2 years of clinical coding experience with strong attention to detail and a high level of accuracy preferred.
• Ability to speak and provide presentations and education to small and large groups alike.
• Ability to work a flexible work schedule and willingness to travel (locally) as determined by business need.
• One or more of the following Licenses/Certifications required: CDI, CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, CPMA.

Skills

• Knowledge of HEDIS, abstraction concepts, and Medicare Risk Adjustment preferred.
• Ability to assess population health needs and define health improvement priorities.
• Excellent verbal and written communication skills.
• Self-motivated and accountable for project coordination and follow-through.
• Strong organizational and planning skills.
• Ability to meet deadlines and produce accurate work product.
• Ability to handle multiple tasks simultaneously.
• Ability to work well independently.
• Maintain strong clinical knowledge and understanding of Evidence-Based Practice principles.
• Define and educate regarding appropriate sources for standards of care.
• Ability to review and analyze population data and metrics to inform program development.
• Create, build, and maintain relationships to improve performance, establish trust, and maintain credibility throughout the organization.
• Impact and influence: ability to make a difference.
• Demonstrate adaptability and flexibility in the face of changing demands.
• Demonstrate willingness to perform additional tasks as assigned.
• Display initiative to improve relative to job function.
• Contribute ideas to help improve processes and abstracting data.
• Demonstrate an understanding of and alignment with Martin’s Point Values.

Pay

$86,926.10 - $107,379.30 annually. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable.

Benefits

• Comprehensive benefits package including medical, dental, and vision.
• Retirement savings with employer contributions.
• Paid time off, including volunteer time off.
• Pie day and other employee benefits.