CDI Coding Specialist I
The CDI Provider Engagement Specialist engages providers via electronic tools and (regional) face to face visits to promote the concept and understanding of the Clinical Documentation Improvement Program. They are relied on as coding subject matter expert for the organization and will represent the organization in dealing with vendors, delegated entities and providers. Under the direction of the Senior Manager of RPM Education, Risk Adjustment Provider Engagement Specialist will collaborate with providers and coding teams to deliver education on documentation best practices that result in accurate, comprehensive medical record that reflects the diagnoses for the patient and supports patient care and correct reimbursement.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Acts as a resource for Providers and Coding staff
- Keeps abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI current trends
- Effectively utilizes ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results.
- Serves as an expert resource in reviewing all medical records in support of accurate documentation for all payer types to assure complete and accurate diagnosis and procedure capture and coding.
- Proactively coordinates and engages regular meetings with HIM Coding, Physician Champions and Leadership
- Leads and executes physician education strategies that result in improved clinical documentation and complete capture of diagnosis coding
- Contributes to the overall development and maintenance of the Medicare Advantage internal share point site and related reference materials
- Engages providers at various audience levels via electronic tools and face to face encounters (group and/or one-on-one session) to promote the concept and understanding of Clinical Documentation Improvement.
- Supports, monitors, and reports key performance indicators (KPIs) to Senior Management
- Monitors trends in the CDI process and develops and implements action plans to maximize the program.
- Develops and implements CDI strategies, provides analysis and makes recommendation for process improvement.
- Maintains expert knowledge of CDI and ICD-10 Coding
- Keeps abreast of current changes in coding and reimbursement requirements for government programs and other third party payers.
- Reviews Medicare and Commercial payer publications on a frequent basis and develops coding education in a proactive fashion to add value to the overall quality of clinical documentation.
- Actively participates in meetings and/or seminars and disseminates the information to peers to enhance the knowledge and skills of the department.
- Other duties as assigned.
- Strong working knowledge of physician coding rules and guidelines
- Ability to interpret, analyze and abstract data/documentation
- Excellent verbal and written communication skills
- Strong team player with the ability to work under minimal supervision
- Ability to travel (75%)
- Excellent prioritization and organizational skills
- Takes initiative and has positive attitude
- Ability to work in a continuously changing environment, flexible
- Customer Service - interacts positively with all internal and external customers and takes immediate action to meet customer needs.
- Interpersonal/Communication/Relationships - builds effective working relationships and treats others with respect.
- Information Management - accesses, uses and presents information as relevant to position; demonstrates knowledge of HIPAA privacy and security rules and uses medical information as appropriate to position.
- Initiates collaboration with others outside of department as needed
- Demonstrates commitment to the principles and ethics of the organization
- Must have specific knowledge of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, and billing compliance rules.
- Associates degree required
- Bachelor degree preferred
- RHIT, RHIA, CPC, CPMA, CRC
- Certified Medical Coder, must have AAPC or AHIMA certification at a minimum
- Computer skills, including Microsoft Office suite of products
- Experience in multi-specialty physician coding is highly preferred
- Minimum of 5 years of clinical experience
- Minimum 5 years production coding
- Minimum 3-5 years CMS compliance guidelines
- Minimum 2 years working at a health plan
- Must have Medicare Risk Adjustment coding experience
If you have any questions, please call 904-998-9414 and reference CDI Coding Specialist I position.
Job Status: Full Time