Clinical Documentation Improvement Specialist

Summary

Join One Medical's Medicare Risk Operations team as a Clinical Documentation Integrity (CDI) Specialist and contribute to high-quality patient care. This remote, full-time position involves reviewing medical records to ensure complete and accurate documentation, supporting Medicare Risk Adjustment, and educating staff on clinical documentation and coding guidelines. You will work collaboratively with clinicians, utilize compliant query processes, and contribute to various projects. The ideal candidate possesses strong attention to detail, excellent communication skills, and a minimum of 3 years of experience as a CDI Nurse or similar role. A Registered Nurse (RN) license or BSN is required, along with knowledge of Medicare Advantage and HCC coding. One Medical offers a competitive salary and a comprehensive benefits package.

Requirements

• Minimum 3 years working as Clinical Documentation Specialist (CDS) Nurse or Clinical Documentation Integrity (CDI) Nurse
• Must be a Registered Nurse (RN) or have Bachelor’s Degree in Nursing (BSN)
• Minimum of 3 years inpatient or internal nursing experience required
• Knowledge of age-specific needs and the elements of disease processes and related procedures
• Working Knowledge of the Medicare Advantage reimbursement system and HCC Coding required
• Working knowledge of HEDIS quality specification
• Excellent written and verbal communication skills
• Excellent critical thinking skills
• Ability to work independently in a time-oriented environment
• Tech savviness. Strong proficiency in Microsoft Windows, Word, Excel, PowerPoint and the Google suite of products, including Gmail and Calendar

Responsibilities

• Reviews office notes of patients to identify the diagnoses in the HCC model and to assign a working HCC. Performs initial reviews, concurrent reviews and retrospective reviews to ensure there is adequate supporting documentation for HCC diagnoses in the note
• Educates internal staff on clinical documentation and coding guidelines. Develops and conducts ongoing CDI education for new staff including coders, physicians, nurses, and behavioral health specialists
• Develops and supports strong professional relationships with medical providers across the system
• Does review sessions with clinicians in local markets via video or face to face when possible
• Utilizes a compliant query process per guidelines and policy when conducting all queries. Follows each query through to closure including complete documentation of ongoing follow up activities and communication
• Prospectively generates suspect conditions based on findings from chart review and assists in the creation of decision support logic
• Assists in other monitoring activities, special department projects or other needs as determined by the department manager
• Provide ongoing CDI team learning opportunities through sharing of professional knowledge
• Maintains integrity and compliance in all chart reviews and CDI documentation and queries at all times
• Review medical records to identify documentation that supports closure of HEDIS and other quality gaps and with other cross functional teams to submit to health plans via attestation or electronic filings as appropriate
• Works closely with Operations Manager to implement MRO initiatives

Preferred Qualifications

CCS, CCDS or CDIP preferred

Benefits

• Paid sabbatical for every five years of service
• Free One Medical memberships for yourself, your friends and family
• Employee Assistance Program - Free confidential services for team members who need help with stress, anxiety, financial planning, and legal issues
• Competitive Medical, Dental and Vision plans
• Pre-Tax commuter benefits
• PTO cash outs - Option to cash out up to 40 accrued hours per year
• 401K match
• Credit towards emergency childcare
• Company paid maternity and paternity leave
• Paid Life Insurance - One Medical pays 100% of the cost of Basic Life Insurance
• Disability insurance - One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance
• Malpractice Insurance - Malpractice fees to insure your practice at One Medical is covered 100%
• UpToDate Subscription - An evidence-based clinical research tool
• Continuing Medical Education (CME) - Receive an annual stipend for continuing medical education
• Rounds - Providers end patient care one hour early each week to participate in this shared learning experience
• Discounted rate to attend One Medical’s Annual REAL primary care conference