Clinical Documentation Integrity Specialist Nurse

Immanuel • Omaha, NE

1d • Onsite

About The Position

Immanuel Pathways PACE® is seeking a Clinical Documentation Integrity Specialist Nurse to join their team at their Home Office in Omaha, NE. This role utilizes advanced clinical coding expertise to direct efforts towards the integrity of clinical documentation through the roles of review, educator, and consultant. It facilitates the overall quality, completeness, accuracy, severity of illness, and integrity of medical record documentation to support correct coding and reimbursement. This role bridges clinical care and administrative processes, focusing on improving recapture rates and compliance with CMS-HCC risk adjustment models. Supports and lives out Immanuel’s Mission and CHRIST Promises.

Requirements

• Bachelor of Science in Nursing required.
• Five (5) years of clinical experience
• Three (3) years of experience coding ICD-10 CM and experience in ICD-10 CM in a risk adjustment environment.
• Must possess valid medical coding certification in one of the following areas: Certified RN Coder (CRN-C), Certified Clinical Documentation Specialist (CCDC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist designation (CCS), Certified Professional Coder (CPC)
• Applicants must be currently authorized to work in the United States on a full-time basis.

Nice To Haves

• Equivalent years of education may substitute for experience requirement.

Responsibilities

• Conduct concurrent review of participant medical records to identify incomplete, inaccurate, or inconsistent clinical information.
• Initiate and manage compliant, non-leading queries to providers to clarify documentation and ensure clinical accuracy.
• Collaborate with external medical coding company to ensure that clinical documentation supports the assignment of appropriate diagnosis and procedure codes.
• Collaborate and provide on-going education and training with providers and interdisciplinary team members to clarify documentation and improve coding accuracy and the importance of complete, accurate chart documentation to support reimbursement.
• Analyze clinical data to identify documentation trends, measure the impact of improvement initiatives, and report findings to leadership.
• Serve as a subject matter expert and liaison between clinical, coding, and quality departments to resolve documentation discrepancies.
• Develop provider education curriculum relating to risk adjustment coding and documentation best practices, research and update internal coding compliance and policies in accordance with CMS-HCC (v22/V28) guidelines and ICD-10-CM/CPT II coding standards.
• Develop coding tips, newsletter articles, and clinical documentation initiatives to ensure diagnoses are documented with the specificity and detail required for Hierarchical Condition Categories (HCC).
• Collaborate with Director to develop fully informed views and insights into the drivers behind data, and present findings clearly and concisely.
• Monitors and analyze data and quality review processes, evaluating results and recommending appropriate action/training.
• Prepare detailed reports for management and other departments by analyzing and interpreting data.
• Assists with special project assignments.
• Performs other duties as assigned or requested.

Benefits

• Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
• Employer Paid Life Insurance
• Paid Time Off - accruing from day one of employment, Floating Holidays, Paid Holidays, 8 hours of Volunteer Time Off per year
• 401K with employer match
• Wellness Program and Employee Assistance Program
• Advancement opportunities (as appropriate) – we look to grow from within our organization
• Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level