Clinical Documentation Integrity (CDI) Specialist - Outpatient

The Outpatient Clinical Documentation Integrity (CDI) Specialist is a key figure in enhancing patient care. Serving as a bridge between providers, coders, and the revenue cycle, you will use your clinical knowledge, national coding, and compliance guidelines to clarify at-risk or incomplete documentation and ensure complete and accurate claim submissions. Your responsibility for reviewing patient medical records in the clinic setting to capture an accurate representation of risk adjustment and facilitate proper coding is crucial. It directly influences the quality of care our patients receive and the accuracy of our clinical practices. This Outpatient CDI role is not just a job but a dedication to the patients attributed to RIPCPC.

To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation.

• →Possess expertise in how proper provider documentation drives the coding accuracy for complexity and medical necessity, improving the quality of care and patient outcomes for outpatient services and associated risk adjustment.
• →Demonstrate the ability to build strong working relationships with clinicians, administrators, and revenue cycle colleagues.
• →Ability to abstract clinical data from medical record documentation to produce queries for missed medical diagnosis opportunities.

• →Conduct pre and post visit audit to ensure the accuracy and completion of the medical record documentation for claims submission and reimbursement.
• →Work independently with minimal supervision while utilizing one's own strong work ethic, time management, and problem-solving skills.

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  • →Leverage strong communication skills to bridge interrelated concepts, business functions, and processes to deliver results through an Outpatient CDI program.
  • →Understand various payment structures, fee schedules, reimbursement methodologies in the outpatient setting and physician encounters, and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet reporting requirements.
  • →Utilize EHR to prioritize encounters for review and accurately enter data in Dynamics Tool (Microsoft product internally built to our process needs) to ensure the integrity of tracked data for reporting key performance indicators, including productivity, physician engagement, and potential financial impact.
  • →Knowledge of, but not limited to, current coding guidelines and methodologies: HCCs, ICD-10-CM coding guidelines, Office of Inspector General (OIG), and other government mandates
  • →Extensive knowledge of medical terminology, anatomy, pathophysiology, pharmacology, and ancillary test results
  • →Possess strong organization and analytical thinking skills and is detail-oriented

The position serves both employed and independent providers and clinicians in RIPCPC clinics.

Access to and work with sensitive and confidential information.

Exhibit a comprehensive understanding of healthcare regulatory and compliance (e.g., HIPAA) information. Skilled in the application of policies and procedures. Knowledge of business office standards and recommended practices.

This Position is 100% Remote.

• Education: Preferred Risk Adjustment Coder and/or the certifications listed below.
• Experience: A minimum of 3 years of ambulatory risk adjustment coding experience with some clinical knowledge preferred.

A Certified Risk Adjusted Coder (CRC) is preferred. Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) certifications will also be considered.

This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients’ acute and chronic conditions

• ICD-10-CM Coding experience
• Ability to work independently with minimal supervision after training
• Knowledge of HCCs and risk models
• Proficient critical thinking, reasoning, and deduction to draw accurate clinical conclusions
• Ability to navigate various electronic health records and utilize AI/NLP technologies
• Positive attitude and team player
• Ability to collaborate with providers