Job Description:The Clinical Documentation Specialist, Risk Adjustment role will work closely with our Burden of Illness, Clinical, and Compliance teams to participate in our Clinical Documentation Integrity program and leverage the clinical, coding, and documentation expertise to foster improvements in compliance of clinical documentation.
Responsibilities:
- Reviews upcoming visits to validate persistent (chronic) conditions and raise potential suspect conditions for provider to assess
- Utilizes various systems to find clinical support to assist in closing risk adjustment gaps
- Responsible for ensuring documentation rules, coding guidelines and company compliance guidelines are met
- Performs assessments of data to improve overall operations and identify opportunities for provider education and optimization
- Serves as a subject matter expert on Hierarchical Condition Category (HCC) documentation requirements and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding guidelines
- Develops and supports strong professional relationships with medical providers across the organization
Work Experience: - 5+ years of overall experience;
- 3+ years of Clinical Documentation Integrity (CDI) specific experience.
- Medicaid documentation requirements understanding is a plus
We take into account an individual's qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company's equity program, paid time off, including vacation and sick leave. The actual offer will be at the company's sole discretion and determined by relevant business considerations, including the final candidate's qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is:
$71,000.00 - $90,500.00 Annual
