The Clinical Documentation Information Specialist is accountable for reviewing patient medical records 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 CDM education for new staff including coders, physicians, nurses, and behavioral health specialists.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- 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.
- CDI will support and implement quality measures as identified by department Director.
- Works closely with Operations Director to implement MRO initiatives.
EDUCATION AND SKILLS
- 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.
- Tech savviness. Strong proficiency in Microsoft Windows, Word, Excel, PowerPoint and the Google suite of products, including Gmail and Calendar.
SALARY AND BENEFITS:
- Paid Time Off
- Sick Time
- Medical, Dental, Life and Long/Short term disability Insurance.
- Paid Association Dues Paid
- Educational Benefits
AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer
We encourage minority and female applicants to apply.
AMN Healthcare is committed to fostering and maintaining a diverse team that reflects the communities we serve. Our commitment to the inclusion of many different backgrounds, experiences and perspectives enables our innovation and leadership in the healthcare services industry. Apply today and one of our team members will be in touch to help you find the role that best fits your skills and goals.