Clinical Documentation Advisor

Dartmouth-Hitchcock Health • Lebanon, NH

1d

About The Position

Assumes responsibility for regulatory coding and documentation audit and education activities with providers, clinical and ancillary staff. Serves as a primary resource and advisor to clinical sections on regulatory coding, documentation requirements, charge capture tools, and documentation tools in eD-H. Uses data analysis and chart reviews to identify trends, support accurate revenue capture, and address regulatory compliance. Reports regulatory compliance activities to the Compliance Office quarterly.

Requirements

• Associate degree in a related field or equivalent.
• Five years of recent coding experience.
• Certified Professional Coder (CPC), Certified Professional Coder–Hospital (CPC-H), or Certified Coding Specialist–Physician Based (CCS-P) certification.
• Demonstrated proficiency in CPT, ICD-10, and HCPCS coding, including E/M code assignment, auditing, and education.
• Strong organizational and analytical skills.
• Ability to communicate effectively, orally and in writing, with all levels of staff.
• Attention to detail.

Nice To Haves

• Background in a multi-specialty coding setting preferred.
• HCC Risk Coding background is a plus.

Responsibilities

• Perform regulatory coding and documentation audits and education activities for providers, clinical staff, and ancillary staff.
• Serve as the primary resource to clinical sections on regulatory coding and related documentation rules and regulations.
• Develop the Annual Education Plan and coordinate coding education activities in assigned departments, including routine record reviews, ongoing daily education, and orientation for new provider staff.
• Advise on charge capture tools and the development of documentation tools in eD-H.
• Identify trends through data analysis or chart review, review existing policies for accuracy, and develop new policies as necessary.
• Apply mandated regulatory, documentation, and coding guidelines, including CPT, ICD-10, HCPCS, and E/M code assignment, auditing, and education.
• Identify key issues and share pertinent information with clinical sections and management to support accurate revenue capture; elevate regulatory concerns to management.
• Report regulatory compliance activities to the Compliance Office quarterly.
• Perform other duties as required or assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree