Outpatient CDI Specialist

Medical University of South Carolina

1d•Onsite

About The Position

The Outpatient CDI Specialist is a hybrid role that combines the expertise of clinical documentation improvement (CDI) and outpatient Hierarchical Condition Category (HCC) coding. This position will report to the Outpatient CDI Program Manager. The role focuses on improving the accuracy, quality, and completeness of clinical documentation in outpatient medical records while ensuring compliance with coding guidelines. The specialist will work collaboratively with providers, coding teams, and other healthcare professionals to facilitate accurate coding, improve risk capture, and optimize reimbursement while reflecting the true severity of illness and care provided.

Requirements

Registered Nurse (RN) with at least 3 or more years' experience either in the clinical field (RN), CDI field, or coding field.
Experience in an outpatient or acute care setting.
Ability to work independently, be resourceful, and possess strong organizational skills.
Ability to communicate effectively with physicians and other clinical staff; be courteous and professional.
Active certification from one of the following: AAPC (Certified Professional Coder - CPC, or Certified Documentation Expert – Outpatient CDEO), AHIMA (Certified Coding Specialist – CCS or Certified Documentation Improvement Practitioner – CDIP), ACDIS (Certified Clinical Documentation Specialist - CCDS or CCDS-O). Candidates without a certification must obtain one within the first year of employment.
Bachelor's degree in Nursing from an accredited school of nursing.
Minimum of five years clinical nursing experience.
Strong clinical experience and critical thinking skills.
Extensive knowledge of patient care, and knowledge of clinical measurement tools and clinical outcomes.
Ability to establish cooperative working relationship with diverse groups and individuals, medical staff and other health care disciplines.
Licensure as a registered nurse by the South Carolina Board of Nursing or compact state.
Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification.

Nice To Haves

1 or more years' experience in HCC/Risk Adjustment.
Minimum of 3 years of experience in clinical documentation improvement, outpatient Hierarchical Condition Category (HCC), or a combination of both.
Proficiency in ICD-10-CM.
Program and database development a plus.

Responsibilities

Conduct concurrent and retrospective reviews of medical records to ensure clinical documentation captures the full scope of patient severity, risk of mortality and medical necessity for outpatient services.
Collaborate with physicians, nurse practitioners, case managers and coder to identify opportunities for improving documentation of diagnoses, procedures and medical necessity.
Query providers in a compliant and clear manner to address documentation gaps, ambiguities or discrepancies to support accurate coding and billing.
Educate providers and clinical staff on best practices for documentation to improve encounter accuracy and quality.
Accurately assign ICD-10 CM for outpatient encounters, including clinical visits, emergency department visits, ambulatory surgeries, laboratory services and observation care.
Abstract data and input into electronic medical record systems while adhering to organizational and regulatory coding standards.
Ensure coding accuracy meets or exceeds a 95% accuracy rate, following official ICD-10-CM guidelines.
Maintain complete confidentiality of patient information and adhere to HIPAA regulations and organizational policies.
Ensure documentation and coding practices meet compliance standards for regulatory and payer requirements.
Act as a liaison between clinical providers and HIM to bridge the gap between documentation and coding requirements.
Participate in education for providers on coding and documentation standards, focusing on outpatient services.
Participate in ongoing education and stay current with changes in coding guidelines, CDI practices, and healthcare regulations.