Outpatient Clinical Documentation Specialist
Job Description:
- Provide clinically based prospective, concurrent, and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements
- Review risk adjustment gap lists for members, including suspect conditions
- Perform chart reviews to determine clinical validity of open gaps
- Utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers
- Facilitate appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality
- Track and Trend CDI findings and provider engagement for clinical documentation education purposes for any specialty within the hospital system
Requirements:
- Bachelor’s degree in Nursing or Health Information Management is required
- Minimum 5 years related experience working on the payer or provider side in Risk Adjustment Validation including prospective documentation reviews and pre-visit planning
- Certified Risk Adjustment Coder required
- Population Health experience, NCQA/HEDIS CDS experience preferred
- Knowledge of care delivery documentation systems and related medical record documents
- Excellent understanding of ICD10CM coding and guidelines
- Ability to work independently in a time-oriented environment
- Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
Benefits:
- Health insurance
- Discretionary annual bonuses
- Merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
- Resources to support employee and family well-being
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