Ambulatory Clinical Documentation Integrity Specialist (Remote)

Trinity Health • Livonia, MI

6d • Remote

About The Position

Purpose Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization’s strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge. Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression) Obtain appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate. Validate the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers. Conduct thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process. Identify areas where documentation requires clarification & engagement with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies. Ensures medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity. Applies through understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission. Identifies patterns & trends impacting documentation & coding & acts as a technical resource related to documentation, coding & billing regulations for assigned service area.

Requirements

• Associate’s degree in Business, healthcare, Nursing or related field, or equivalent combination of education & experience
• Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, integrated health care delivery system, revenue cycle or consulting experience.
• Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI), Certified Clinical Documentation Specialist – Outpatient (CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Integrity Practitioner (CDIP) credential with coding or clinical documentation integrity experience.

Nice To Haves

• Bachelor’s degree in nursing, HIM or related healthcare field.

Responsibilities

• Obtain appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate.
• Validate the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers.
• Conduct thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process.
• Identify areas where documentation requires clarification & engagement with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies.
• Ensures medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity.
• Applies through understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission.
• Identifies patterns & trends impacting documentation & coding & acts as a technical resource related to documentation, coding & billing regulations for assigned service area.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees