Clinical Documentation Improvement Lead

Healthcare Outcomes Performance Company • Phoenix, AZ

1d

About The Position

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.

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