Departmental Preferences: * Certification in risk adjustment coding (CRC) * Prior experience in medical record auditing (CMS, RADV, Part C IPM) * Medicare risk adjustment experience * Clinical knowledge/experience a plus The Clinical Documentation Improvement Reviewer performs concurrent medical record reviews to ensure that all conditions reported by the provider reflect the severity of illness of the patient. This position is responsible for the validation of diagnosis codes in CDI alert and the identification of missing diagnosis so that patient severity of illness is properly reflected in the medical record. * Conducts an extensive analysis of patient records to evaluate documentation of HCC diagnoses. * Obtains and promotes appropriate clinical documentation through extensive interaction with physicians (via queries) to ensure that the documentation of HCC codes is accurate. * Reviews medical records to ensure that diagnoses are reported in accordance with CMS and ICD coding documentation guidelines. * Maintains working relationships with medical directors and practice engagement coordinators. * Compiles data to determine areas of coding documentation improvement for physician and staff training. * Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment. * Performs on-site or electronic medical record reviews to ensure capture of all relevant diagnosis is based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. * Other duties as assigned. QUALIFICATIONS * High School degree or GED equivalent required. Bachelor's degree in a related field preferred. Successful completion of a coding license or certificates; Credentialed Coder Certificate/License (CPC, COC, CRC, CCS-P, CCS) required. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward clinical documentation certification is highly preferred and encouraged. * Minimum of three (3) to five (5) years of HCC specific coding experience and physician queries required. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: * Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes. * Excellent organization and problem-solving skills. * Strong oral and written communication skills. * Extensive knowledge of ICD-9CM and ICD-10CM coding guidelines. * Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint * Demonstrated ability to utilize a variety of electronic medical records systems. * Ability to manage a significant work load, and to work efficiently under pressure, while meeting established deadlines with minimal supervision. * Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization. * Strong time management skills. * Must possess a high degree of accuracy, efficiency, and dependability. * Excellent written and oral communication for representation of clear and concise results. WORKING CONDITIONS: * Work is performed in an office setting with no unusual hazards. Requires transporting, pushing, pulling, and maneuvering items weighing up to 25 pounds. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $58,500 and $98,100. EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability. Candidates are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
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