Clinical Documentation Improvement Partner

Summary

Join Evergreen Nephrology as a Clinical Documentation Improvement Partner and partner with physician practices to enhance documentation strategies and regulatory compliance. You will translate healthcare documentation into standardized codes, ensuring accurate coding and billing. Serve as a subject matter expert in coding and documentation improvement, advising and educating physicians on best practices. Maintain a high productivity rate and stay updated on coding guidelines and regulatory changes. Contribute to enterprise-wide quality initiatives and create performance improvement projects. Audit medical records and develop training programs to improve documentation quality. Collaborate with other departments to optimize the documentation improvement process. This role requires strong coding knowledge, medical terminology proficiency, and familiarity with healthcare regulations. Evergreen offers a competitive compensation package, including benefits and professional development opportunities.

Requirements

• Strong knowledge of ICD-10-CM, Category II and CPT
• Proficiency in medical terminology, anatomy, and physiology
• Familiarity with healthcare laws, regulations, and other applicable guidance, such as Medicare, Medicaid, HEDIS, and CMS performance measures
• Knowledge of risk adjustment methodology and Hierarchical Condition Categories (HCC)
• Ability to analyze complex medical records, identify documentation gaps, and determine appropriate queries
• Strong written and verbal communication
• Meticulous attention to detail that ensures a high level of accuracy in your work
• Ability to identify discrepancies in clinical documentation and partner with providers to resolve issues efficiently
• Familiarity with electronic health records (EHR), CDI software, and healthcare documentation systems is essential
• High school diploma, GED, or suitable equivalent
• 2+ years recent outpatient medical coding experience
• Must possess one of the following coding credentials: CPC, CRC, CCS, or similar
• Intermediate skills with MS Office Suite of products including Outlook and Teams
• You have the ability to work effectively in a primarily remote environment: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wired to the house internet (Cable, Fiber, or DSL) and hardwired to the internet device is recommended
• Team Members must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

• Review physician practice partners’ diagnosis codes for accuracy based on documented information, ensuring compliance with regulatory requirements and that the assigned codes accurately represent the clinical information documented by the provider
• Ensure that documentation supports appropriate level(s) of care and severity of illness when applying ICD-10, CPT, and other relevant codes for billing and regulatory
• Maintain a 95% productivity rate
• Engage and partner with physicians and other healthcare providers to clarify documentation and confirm that diagnoses and procedures are properly documented in compliance with applicable clinical standards, while also advising on improvement
• Determine when provider claims must be withheld or withdrawn and professionally engaging with partner practices to align on improvement efforts and compliance
• Stay updated on current coding guidelines, clinical protocols, and regulatory changes, including Medicare and Medicaid guidelines on billing and coding, to support provider compliance therewith
• Assist in improving the quality of clinical documentation enterprise-wide and with our physician practice partners to support various quality initiatives, such as HEDIS, CMS, and other contractual or enterprise-initiated performance metrics
• Create and implement performance improvement projects aimed at improving documentation practices and outcomes
• Audit medical records to identify trends in documentation, both positive and negative, to improve documentation practices and provider education efforts
• Develop and provide ongoing education to clinical staff, coders, and other healthcare providers on best practices in clinical documentation, coding guidelines, and regulatory
• Develop individualized training programs to address documentation deficiencies and improve overall documentation quality
• Collaborate with other departments such as compliance, revenue cycle, and quality management to optimize the documentation improvement process
• Other duties as reasonably

Preferred Qualifications

• Associate’s or Bachelor ‘s Degree in nursing (BSN/ASN), health information management (HIM) or related healthcare field
• HCC coding experience

Benefits

• Competitive base pay with bonuses
• Paid time off starting at four weeks for full-time employees
• 12 paid holidays per year
• Reimbursement for continuing medical education
• 401k with match
• Health, dental, and vision insurance
• Paid parental leave
• Robust training and development program