Part Time - Clinical Documentation Integrity Specialist (CDIS)

As a CDIS, you will

• Perform prospective, retrospective, and concurrent coding reviews based on evaluations of prior visit documentation, lab results, images, external medical records, payer claims data, and more
• Demonstrate an understanding of complications, comorbidities, case mix and the impact of procedures on the billed record as well as the ability to impart this knowledge to providers and other members of the healthcare team.
• Support pre-visit planning by communicating to firsthand providers individuals’ potential chronic conditions and care gaps with robust and appropriate evidence
• Ensure accurate, timely, and comprehensive clinical documentation to support code capture, including querying providers when these clinical documentation standards are not met
• Support medical records requests when providers require additional information prior to addressing and diagnosing potential conditions
• Work with team leadership to identify chronic condition prevalence trends by individuals’ demographics; identify and execute potential interventions, e.g., ongoing education to firsthand providers and the CDI team, ongoing quarterly retrospective reviews of unaddressed suspects

Minimum Qualifications

• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) from AAPC in good standing
• An Associate’s or Bachelor’s degree in a healthcare related field with RHIA, RHIT, CRC or CCS credential, RN or LPN license is required
• Minimum of 5 years of risk adjustment-focused medical record review and ICD-10 coding experience, specifically using the Medicare HCC model, in multiple settings (e.g., inpatient, outpatient) Fluent knowledge of ICD-10 CM Official Guidelines for Coding and Reporting, and AHA/AMA/CMS coding resources, to support audit findings
• Ability to gain proficiency in and apply productivity tools, such as spreadsheets, Google Suite, and EHR systems
• Excellent written and verbal communication skills, especially to maintain working relationships with firsthand providers (APNs, NPs), other CDISs, Medical Records Specialists, and others
• Proven experience working remotely
• Alignment to firsthand’s mission, vision and values: Demonstrate respect, dignity, empathy, and professional conduct to both individuals that firsthand serves and firsthand team members

Competencies:

• Demonstrate mastery of the Medicare HCC model, clinical coding guidelines/methodologies, and AHIMA/ACDIS ethical standards of coding; self-motivated to stay abreast of CMS rules and incorporate those changes into daily work
• Proficiency in tracking down, leveraging, and reviewing high volumes of internal and external data (e.g., medical records) to support pre-visit planning and appropriate code capture
• Self-starter with a high degree of drive, initiative, and follow through; comfortable and motivated to work in a fast-paced, ever-changing environment with a passion for problem solving
• Exceptional interpersonal, written and verbal communication skills; proven ability to collaborate across multiple teams and engage in multiple perspectives to work toward a common goal
• Query providers in an ethical manner and track compliance
• Develop CDI policies and procedures to include query process, education and training, and performance tracking
• Bonus but not necessary: familiarity with Medicaid risk models, such as CDPS or ACG