Clinical Documentation Improvement Specialist

InterMed | South Portland, ME

Posted Date 1/13/2018
Description
Job Responsibilities:

The Clinical Documentation Improvement Specialist will facilitate improved quality and completeness of medical record documentation by conducting proactive reviews of patients’ electronic medical records. This review will occur in advance of scheduled patient office visits to ensure all gaps in care are identified and addressed by the provider during that visit.  S/he will be responsible for assisting the Organization in maximizing risk adjustment scores by reviewing ICD-10 coding within the medical record for maximum specificity and supporting documentation. 

ESSENTIAL FUNCTIONS
• Conducts proactive review of the medical record to include:
o Review diagnosis coding
o Identifying co-morbidities and complications
o Capturing all appropriate secondary diagnoses
o Ensuring timely, accurate, and complete documentation of clinical information used for measuring and reporting provider outcomes.
• Works in collaboration with our Coding Department to:
o Provide education to Providers and supporting clinical care teams on documentation, coding changes, and compliance Issues
o Monitor changes in laws, regulations, rules, and code assignments that impact documentation and reimbursement
• Identifies issues and trends in coding and documentation that affect patient risk scores
• Provides input and valuable feedback on audit results as applicable
• Provides ICD10 - CM coding training, as it relates to HCC coding, as requested
• Develops relationships with providers and communicates guidelines and requirements of Risk Adjustment Payment System to ensure correct coding and documentation
• Maintains knowledge of related regulations and requirements supporting ACA/Commercial Risk Adjustment Data Validation
• Completes and tracks all Patient Assessment Forms as requested by health plans


Job Qualifications: • Associates’ degree in Nursing or higher required; Bachelor’s Degree in Nursing Preferred
• Active, unencumbered Maine RN license
• Recent clinical experience (minimum 5 years), preferably in primary care setting
• Experience with EMR, preferably eClinical Works
• Certified Risk Adjustment Coder or ability to obtain certification within 6 months from date of hire
• 1+ years recent experience ICD-9/10 coding with strong attention to detail and high accuracy rate preferred
• 1+ years of recent Risk Adjustment/HCC Coding experience preferred
• Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint)
• Working knowledge of health plan/insurance terminology and concepts
• Excellent professional judgment and decision making ability
• Flexibility and willingness to work both independently as and as a team member in a developing program
• Strong organizational and prioritization skills
• Excellent oral and written communication skills adaptable to individuals with varied levels of understanding at all levels of the organization
• Highly developed problem solving and deductive reasoning skills
• Dependable, self-directed, and diplomatic
• Able to participate collaboratively with all members of the care team
• Knowledge of HEDIS, abstraction concepts, Medicare Risk Adjustment and CMS risk adjustment guidelines preferred
• Must meet deadlines and produce accurate work product
• Must be able to handle multiple tasks at the same time and work well independently

Other Job Information (if applicable): 40 hours a week, Monday through Friday 8:00am to 5:00pm.   
Geographic Region
Greater Portland/Casco Bay
Industry
Healthcare

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Address100 Gannett Drive
South Portland, ME 04106