|Required Certifications:||CPC or CRN-C or CCS,RN
|Required Experience:||3 to 4 years
|Preferred Experience:||3 to 4 years
The RN, Clinical Documentation Improvement Specialist will evaluate medical records to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual – Clinical Modification (ICD-9-CM and ICD-10-CM). The position will be responsible for the day to day operations of the risk adjustment initiatives provide technical guidance and education to physicians, medical, management and administrative staff regarding coding and medical chart review process and support client compliance with CMS rules and regulations, health plan audit requirements and coding guidelines. The position also assists with the coordination of the data management processes required to obtain needed data, load into necessary databases and produce reports.
- Support client providers in proper medical record documentation and HCC reimbursement methodology.
- Provide technical guidance to medical management and claims staff in identifying and resolving issues or errors, such as:
Incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines
Educate and advise staff on codes, documentation, procedures, and requirements
Identify training needs, prepare training materials, and conduct coaching for physicians and support staff to improve skills in the review and audit of coding quality health data.
- Audit client medical record documentation to assess coding accuracy to fulfill regulatory requirements, assess that diagnoses are appropriately documented and supported according to applicable rules and regulations.
- Perform prospective and retrospective coding reviews and other coding activities as required.
Adhere to official coding guidelines.
- Provide direct service for providers including.
- Scheduling trainings, reviews, reports
Research and provide courteous, accurate and timely response to inquiries by providers as related to risk adjustment projects and reports -
- Support risk adjustment service marketing efforts.
- Review bulletins, newsletters, and periodicals, and attend workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical record coding and documentation.