Clinical Documentation Specialist- Outpatient
About The Position
Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence. The clinical documentation specialist (Outpatient) is responsible for facilitating improvement in the overall quality and completeness of Clinical Intelligence’s recapture and suspecting performance. The specialist will perform reviews of patient records to identify and validate Hierarchical Condition Category (HCC) diagnoses. The specialist will query providers to ensure accurate and complete documentation that supports HCC and condition-related diagnoses, ultimately enhancing RAF score accuracy and improving risk adjustment outcomes.
Requirements
- Strong understanding of CMS, HHS, Medicaid, and Rx HCC models.
- Up to date with industry standards related to HCC documentation, ICD-10-CM coding, AHA Coding Clinics, and Official Coding Guidelines.
- Proficient in the use of electronic medical records and technology enabling solutions.
- Graduate of an accredited nursing education program
- Active and unrestricted Registered Nurse or Advanced Practice Provider license
- Certified Documentation Expert-Outpatient (CDEO) or Certified Clinical Documentation Specialist- Outpatient (CCDS-O) or Certified Documentation Improvement Practitioner (CDIP) and Certified Risk Adjustment Coder (CRC)
- Minimum of 2 years outpatient CDI experience
- Experience navigating Epic, Athena, and Cerner EMRs
- 5 years of clinical experience
Nice To Haves
- Bachelor’s Degree in Nursing preferred
- Ambulatory clinical experience preferred
Responsibilities
- Apply comprehensive knowledge of medical terminology, disease processes, treatment modalities, diagnostic tests, medications, and procedures to identify gaps in the overall quality and completeness of clinical documentation.
- Validate recapture and suspect conditions based on clinical evidence.
- Validate documentation supports reported conditions.
- Create queries reflective of best practice.
- Formulate recommendations to improve clinical logic and workflows.
- Maintain strict confidentiality of patient information in accordance with privacy regulations.
Benefits
- Competitive salary
- Medical, Dental and Vision benefits
- 401k match
- Generous PTO plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
