Ambulatory CDI Specialist

Lifepoint Health • Brentwood, TN

1d • Remote

About The Position

The Ambulatory or Outpatient Clinical Documentation Integrity Specialist (OP CDS) bridges the gap between providers, coders, and revenue cycle using clinical knowledge and coding guidelines to clarify at-risk documentation to ensure accuracy of conditions submitted to payer organizations. The CDS nurse will be accountable for reviewing ambulatory patient medical records to capture an accurate disease burden over the specified population and facilitate proper documentation and coding. The current focus is on identifying opportunities for improved documentation through a 2–3-year EHR (Electronic Health Record) look back among attributed patients in the AdvantagePoint Health Alliance clinically integrated networks.

Requirements

• Active CRC, CDEO or CCDS/CCDS-O certification.
• A minimum of 3 years of “hands-on” clinical experience and risk adjustment experience in an ambulatory setting.
• Inpatient CDI experience in the acute care setting may also be considered.
• License Practical Nurse, Licensed Vocational Nurse, or Registered Nurse licensure preferred.
• Other clinical credentials will be considered on a case-by-case basis.
• Certified Clinical Documentation Specialist - Outpatient (CCDS-O) or Certified Documentation Expert Outpatient (CDEO) preferred or obtained within two years.
• Certified Risk Adjustment Coder (CRC) or Certified Coding Specialist (CCS) a plus in lieu of CCDS-O or CDEO.
• Must be authorized to work in the United States without employer sponsorship.

Nice To Haves

• LPN/VPN or RN licensure is preferred, other clinical experience will be considered on a case-by-case basis.
• Certified Clinical Documentation Specialist - Outpatient (CCDS-O) or Certified Documentation Expert Outpatient (CDEO) preferred or obtained within two years.
• Certified Risk Adjustment Coder (CRC) or Certified Coding Specialist (CCS) a plus in lieu of CCDS-O or CDEO.

Responsibilities

• Demonstrate ability to build strong working relationships with clinicians, administrators, and revenue cycle colleagues.
• Leverage effective communication skills to bridge interrelated clinical concepts to coding guidelines and processes to deliver results through the Outpatient CDI (Clinical Documentation Integrity) program.
• Prioritize and organize time and materials, balancing physician documentation and education needs with competing priorities and deadlines.
• Understand various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting and how physician documentation translates into ICD-10-CM codes for claims submission to meet reporting requirements.
• Subject matter expertise in importance of excellent provider documentation and how it translates into coding accuracy, risk adjustment best practices, and supports medical necessity which improves quality of care and patient outcomes for ambulatory services.
• Deliver educational presentations to physicians (on-boarding, one-on-one, or routinely), group practices, and administration.
• Demonstrate responsibility and accountability for personal development by participating in continuing education internal/external offerings for risk adjustment and/or CDI requirements, ICD-10-CM code assignment and coding guidelines.
• Adherence to HIPAA (Health Insurance Portability and Accountability Act) regulations/standards in maintaining the confidentiality and integrity of all protected health information regardless of format.
• Ability to navigate multiple electronic medical records (EMRs) and side by side technologies to streamline longitudinal record analysis.
• Exhibit commitment to or willingness to learn compliant query practice in query development, structure, provision of relevant choices, and follow-up per the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed