Senior Clinical Documentation Integrity Specialist

LE0066 InnovaCare Partners, LLC

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

The Senior Clinical Documentation Integrity (CDI) Specialist serves as a subject matter expert in diagnostic coding and RAF methodology. His or her performance ensures diagnostic coding accuracy and compliance for primary care clinics and Medicare Advantage health plans. The Senior CDI Specialist reviews clinical documentation and provides feedback to in-house coders, billers, and providers across the company's markets. He or she possesses an excellent ability to work directly with the provider's medical staff, physicians, and targeted groups using educational material, presentations, key performance indicator reports, and other tools. The Senior CDI Specialist works mostly remotely; however, he or she may be required to travel around different locations and states.

RESPONSIBILITIES

• Analyzes the risk adjustment and other data based on diagnoses, medical services, codes, and other indicators for identifying opportunities for improvements.
• Reviews medical documents such as surgical reports, medical visits, and diagnostic reports in order to create educational strategies to ensure correct diagnosis code assignment by the provider.
• Reviews clinical documentation and assigns accurate diagnosis codes according to guidelines and projects.
• Performs coding compliance audits and coding assessments to potential business acquisitions.
• Be able to identify opportunities in diagnosis coding, clinical documentation, and billing within the clinical practice's day-to-day operations.
• Performs on-going educational interventions to providers to close gaps or related data
• Delivers training to physicians, targeted groups, and administrative staff regarding coding topics.
• Maintains a log of audits and education performed.
• Prepares and submits to the supervisor a monthly report of activities performed.
• Participates in training to maintain an understanding of CMS regulations
• Performs other duties relevant to the position.

EDUCATION AND EXPERIENCE

Educational requirements:

• Associates, (preferred) Bachelor's Degree or higher in health information management (HIM), health informatics, biology, nursing, business administration, or related to the health industry from an accredited school.

Professional certifications and experience

• A certificated HIM professional with at least 3 years of experience in Risk Adjustment coding. A HIM certification by one of the following recognized organizations American Academy of Professional Coders (AAPC), American Health Information Management (AHIMA) or Association of Clinical Documentation Integrity Specialists (ACDIS). Examples are CRC, CPC, CIC, COC, CPC-P, CPMA, CDEO, CCS, CCS-P, CDIP, RHIA, RHIT, CCDS, or CCDS-O.
• Or foreign medical degree with at least 2 years of experience in CDI, medical coding, medical billing, and/or medical record reviewing.
• Or a certified medical assistant (MA), licensed practical nurse (LPN), or registered nurse (RN) with an active license and at least 3 years of experience in CDI, medical coding, medical billing, and/or medical record reviewing.
• Or at least 6 years of experience in CDI, medical coding, and/or medical billing.

SKILLS AND ABILITIES

• Must have ability to work as a team player with excellent communication skills.
• Must solve resource issue in a creative, positive manner.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Stay updated on CMS rules and guidelines.
• Must be able to function with frequent interruptions, travel by car or plane to different locations when required, including but not limited to Miami-Dade, Broward, Palm Beach, Orange, Osceola counties.
• Accepts change and able to prioritize activities when faced with competing demands.

GENERAL SKILLS

• Knowledge and interpretation of the systems of standard classification (CPT, ICD-10-CM and HCPCS)
• Knowledge and interpretation of the Risk Adjustment Factor and Stars Program payment methodologies of Medicare Advantage
• Knowledge of correct coding guidelines defined by CMS and other regulatory angencies

LANGUAGE SKILLS

(Preferred) bilingual (English and Spanish). Ability to read, analyze, and interpret general business periodicals, operating and maintenance instructions, procedure manuals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!