The Role
As a member of the Medicare Risk Operations (MRO) team, the CDI specialist will be responsible for supporting Iora Health’s Medicare Risk Operations and Quality teams in reviewing concurrent and retrospective medical records to evaluate the completeness of provider documentation.

This role reports into the Director of Medicare Risk Operations in Boston, MA. Ideally this person will be located in Boston, but we are also open to someone residing in Denver, CO or another Iora market.

Responsibilities:

• Reviews office note 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 CDM 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 market face to face when possible.
• Uses Natural Language Processing software to validate and answer issues by the NLP coders.
• 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.
• Works collaboratively with Medicare Risk Operations Medical Director to ensure positive program outcomes.
• 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 record to identify documentation that supports closure of HEDIS and other quality gaps and with the CP+S/BCI teams to submit to health plans via attestation or electronic filings as appropriate.
• Works closely with Operations Director to implement MRO initiatives.

Qualifications

• Bachelor’s degree in Nursing, Health Information Management or other clinical degree preferred; however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements.
• CCS, CCDS or CDIP preferred.
• 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.
• Minimum 6 years related experience.
• 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.

About Iora Health
Iora Health (www.iorahealth.com) is restoring humanity to healthcare by building a simple yet radically different primary care model from scratch: we know each of our patients as true individuals, and proactively provide them the unique combination of care, support, and inspiration they need to live their best life.

The Iora Health model of health care changes everything - payment, staffing, processes, IT systems, and culture. We have no status quo to defend, no arcane rules we must follow. We are a fast-paced, fresh-thinking, high-growth company building a better model of health care delivery.

Iora Health patients enjoy the benefits of improved access to care, non-office based encounters (e.g. phone, video chat, email, walking groups, etc.), an accessible and transparent medical record, and robust educational offerings. Iora Health practices offer smaller panel sizes, closer relationships between patients and care teams, no billing or coding, and the opportunity to lead systemic change in health care delivery while working with a true team.