Job Title

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 communicat To view the full job description please use the link below.