Ambulatory Clinical Documentation Integrity Specialist (Remote)
About The Position
The Ambulatory Clinical Documentation Integrity Specialist uses specialized knowledge, research, data analysis, critical thinking, and problem-solving to support organizational objectives. The role serves as a peer influencer and may direct projects or project teams. It researches and analyzes information, identifies opportunities, develops solutions, supports performance improvement, and distributes analytical reports. The specialist uses multiple system applications to conduct analyses, create reports, and develop educational materials while prioritizing quality, confidentiality, and safety and maintaining knowledge of departmental processes and applicable policies. The specialist supports ambulatory clinical documentation integrity by interacting extensively with providers and coding staff to obtain complete, accurate documentation reflecting services rendered. The role validates working HCC diagnosis assignments that affect RAF scores, conducts prospective and sometimes retrospective reviews of ambulatory patient records, tracks findings, and works with clinicians to clarify documentation and resolve discrepancies. It supports accurate, complete, and compliant records for acute and chronic conditions and medical necessity; applies knowledge of payment structures, outpatient reimbursement, and HCC risk adjustment; and identifies documentation and coding trends while serving as a technical resource for related regulations. The position also researches and compiles information for operational projects, synthesizes data into detailed summaries and graphical presentations, recommends practical solutions, and uses program and operational measurements to demonstrate progress, return on investment, and impact. The specialist maintains knowledge of applicable laws and regulations and Trinity Health compliance requirements, policies, procedures, and guidelines, and is expected to demonstrate honest, ethical, professional behavior and safe work practices.
Requirements
- Associate’s degree in Business, healthcare, Nursing, or a related field, or an equivalent combination of education and experience.
- Experience with compliant healthcare documentation, HCC coding requirements, and alternate payment models in a multi-facility integrated healthcare delivery system, revenue cycle, or consulting environment.
- One of the following credentials, with coding or clinical documentation integrity 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).
Nice To Haves
- Bachelor’s degree in nursing, HIM, or a related healthcare field.
Responsibilities
- Research, collect, and analyze information; identify opportunities, develop solutions, and lead them through resolution.
- Collaborate on performance improvement activities based on program efficiency and patient experience outcomes.
- Distribute analytical reports.
- Use system applications to perform analysis, create reports, and develop educational materials.
- Research and compile information for ad hoc operational projects and initiatives.
- Analyze and synthesize data, provide detailed summaries and graphical presentations of trends, and recommend practical options or solutions for leadership decision-making.
- Use program and operational data and measurements to define and demonstrate progress, return on investment, and impact.
- Obtain appropriate clinical documentation through extensive interaction with providers and coding staff so documentation accurately reflects the level of service rendered.
- Validate working HCC diagnosis assignments affecting RAF scores in the ambulatory patient population in collaboration with physicians and advanced practice providers.
- Conduct prospective and sometimes retrospective quality reviews of ambulatory patient records, document findings, and track relevant information.
- Identify documentation requiring clarification and engage physicians, advanced practice providers, and other healthcare professionals to resolve discrepancies.
- Ensure medical record documentation is accurate, complete, and compliant, supporting acute or chronic conditions and medical necessity.
- Apply knowledge of payment structures, outpatient reimbursement models, provider documentation, and HCC risk adjustment to support compliant claims reporting.
- Identify patterns and trends affecting documentation and coding and act as a technical resource on documentation, coding, and billing regulations for the assigned service area.
- Maintain knowledge of applicable laws, regulations, compliance requirements, policies, procedures, and guidelines, and follow ethical and safe work practices.
- Demonstrate Trinity Health's Mission, Values, Vision, Actions, and Promise in behaviors, practices, and decisions.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
