Clinical Documentation Improvement Lead

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

2d

About The Position

This role involves leading clinical documentation improvement (CDI) initiatives specifically within orthopedic and musculoskeletal specialties. The lead will be responsible for reviewing provider documentation to ensure it is complete, specific, medically necessary, and accurately coded. A key aspect of the role is collaborating with physicians, advanced practice providers (APPs), coding teams, and operational leaders to enhance documentation workflows and minimize revenue loss. The position requires identifying trends that affect reimbursement, denials, downcoding, charge lag, and documentation deficiencies. The lead will also provide education and feedback to providers on coding, documentation standards, payer requirements, and compliance. This role serves as a subject matter expert for specific workflows, claim edits, charge capture, and operational reporting. Collaboration with coding and denial management teams is essential for resolving documentation-related reimbursement issues. The role supports audit readiness and compliance through chart reviews and documentation monitoring, and assists in creating documentation policies, workflows, tip sheets, and educational materials. Analysis of documentation and coding trends is crucial for operational performance improvement and financial optimization. Monitoring payer policies and regulatory updates impacting MSK documentation and reimbursement is also a key responsibility. Finally, the lead will participate in cross-functional operational meetings and revenue cycle performance initiatives.

Requirements

• Certified Professional Coder (CPC), CCS, RHIA, RHIT, or equivalent coding certification required
• Minimum 5 years of clinical documentation improvement, coding, or revenue cycle experience in orthopedic/MSK specialties required
• Strong working knowledge of musculoskeletal and orthopedic procedural and diagnosis coding

Responsibilities

• Lead clinical documentation improvement initiatives focused on orthopedic and musculoskeletal specialties
• Review provider documentation for completeness, specificity, medical necessity, and coding accuracy
• Partner with physicians, APPs, coding teams, and operational leaders to improve documentation workflows and reduce revenue leakage
• Identify trends impacting reimbursement, denials, downcoding, charge lag, and documentation deficiencies
• Provide education and real-time feedback to providers regarding coding, documentation standards, payer requirements, and compliance expectations
• Serve as a subject matter expert for Athena documentation workflows, claim edits, charge capture, and operational reporting
• Collaborate with coding and denial management teams to resolve documentation-related reimbursement issues
• Support audit readiness and compliance initiatives through routine chart reviews and documentation monitoring
• Assist in the development and maintenance of documentation policies, workflows, tip sheets, and provider education materials
• Analyze documentation and coding trends to support operational performance improvement and financial optimization
• Monitor payer policy changes and regulatory updates impacting MSK documentation and reimbursement
• Participate in cross-functional operational meetings and revenue cycle performance initiatives

What This Job Offers

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