Job title: Clinical Document Improvement Specialist
Company: Fallon Health
Job description: ResponsibilitiesResponsibilities:
- Able to collaborate extensively with physicians, nurses, other caregivers, and medical records coding staff to improve quality and completeness of documentation of care provided and coded
- Assist in the collection and analysis of risk adjustment data in-order to identify documentation, coding trends and opportunities
- Audit medical records for accuracy of coding, ambiguous, conflicting or incomplete documentation.
- Conducts concurrent review of the medical records to increase the accuracy, clarity and specificity of provider documentation.
- Provide feedback to providers and external/internal business partners of audit findings and make recommendations as necessary.
- Keeps current with changes in coding guidelines, compliance, reimbursement, and other relevant regulatory updates
- Develop and coordinate education and training that focuses on Risk Adjustment coding and documentation opportunities utilizing a variety of methods to deliver content, such as direct provider collaboration, power point presentations, teleconferences and webinars.
- Partner with key business areas around provider education, engagement and develop follow up plans where appropriate.
- Collaborate with internal business partners to achieve department objectives and ensure internal risk adjustment compliance and standards are maintained
- Assumes responsibility for professional development by participating in workshops, conferences and/ or in-services.
- May be called on to present to large and/or small groups of executives, physicians and other clinical or financial personnel
- Assist with coding chart review projects and RADV audits
- May be required to Audit vendors and internal coders work
QualificationsEducation:
- Bachelor’s degree or equivalent work experience
License/Certifications:
- Possession of AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders) of any of the following Certified Coding Specialist (CCS), Certified Risk Adjustment Coding (CRC) or Certified Professional Coder (CPC) required.
- RN Licensure preferred
Experience:
- Strong organizational skills in multiple settings, as well as the ability to exercise judgement and initiative
- Strong written, verbal and presentation skills
- Possess Critical Thinking skills
- Competent in MS Office
- Proven/demonstrated knowledge in the following
1.ICD-10-CM Coding/Risk Adjustment HCC coding
2. Regulatory Compliance
3. HIPAA and Legal Aspects of Health Information
4. Medical Reimbursement Methodologies
5. Medical Terminology
- Self-motivation with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member
- Adaptive and flexible to new ideas and change
- Travel to provider offices
- Experience working and interacting with the Provider community
- Preferred: 2 year of Clinical Documentation Improvement (CDI) experience in the inpatient/outpatient setting
- Thorough knowledge of ICD-10-CM, Medicare, Medicaid, Commercial HCC coding guidelines
- Previous experience with Risk Adjustment coding is preferred
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Expected salary:
Location: Worcester, MA
Job date: Thu, 26 Dec 2024 05:37:26 GMT
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