Sr CDI Specialist
Why This Role is Important to Us:
Under the guidance of the Manager for Billing, Coding, & Provider Documentation this position will supportinternal & external clinical and operational coding initiatives at Commonwealth Care Alliance (CCA).
TheClinical Documentation Sr.
Specialist will serve as a primary resource in evaluating medical encounter notes/records housed either at CCA or at contracted primary care sites to ensure completeness, accuracy, andcompliance with the International Classification of Diseases Manual - Clinical Modification(ICD-10-CM) and the American Medical Association's Current Procedural Terminology manual (CPT).
TheCDIS will be responsible for educating and advising CCA internal departments and CCA's primary care sites inMedicaid and Medicare documentation requirements as well as guiding in the identification and application ofappropriate ICD-10 CM & CPT/HCPCS corrective coding techniques to capture CCA member's acuity/chronicdisease profile.
What You'll Be Doing:
Evaluates medical record documentation and corrective coding to optimize reimbursement and ensureadequate collection of clinical quality data; ensures diagnostic and procedural codes and other documentationaccurately reflect and support services rendered as well as data comply with legal standards and guidelines;interprets medical information such as diseases, symptoms and treatment, and diagnostic descriptions andprocedures for a given visit in order to accurately assign and sequence the correct ICD-10-CM and CPT codesand identify all appropriate codes based on CMS HCC categoriesProvides technical guidance to primary care site in identifying and resolving issues or errors, such asincomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that donot conform to approved coding principles/guidelines; educates and advises staff on proper code selection,documentation, procedures, and requirementsCPC/CCS and CRC requiredMaintains a 95% quality audit accuracy rate every monthAttends all clinical site meetings providing support & coding education as neededReviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues,trends, and changes in the laws and regulations governing medical record coding and documentationIdentify training needs, prepare training materials, and conduct education training programs related tocorrective Diagnosis & CPT documentation requirementsDevelops and updates procedure manuals to maintain standards for correct coding, minimize the risk of fraudand abuse, and optimize revenue recoveryServe as a resource for primary care site to answer questions regarding risk adjustment, corrective CPTcoding, Medicare & Medicaid coding guidelines and updatesMaintains all related CDI & Coding Credentials certifications and CEU requirementsAdditional duties as identifiedWhat We're Looking For:
RequiredAssociate's Degree or equivalent experiencePreferredBachelor's Degree --preferredRequired2-4 years experienceAssociate Degree, Bachelor's Degree or equivalent work experience with Coding and documentation reviewand ability to interact and communicate with providers in a collegial manner.
Possession of Certified Coding Specialist designation (CCS, CCS-P, CCA from AHIMA) or CertifiedProfessional Coder (CPC), and Certified Risk Adjustment Coder (CRC) from the American Association ofProfessional Coders (AAPC) is required2-3 years in a Health care setting working with codes and reviewing documentation.
Required2
years clinical experience working within a health care setting performing clinical documentation and CPT/HCPCS coding activities2
years' experience in medical coding in ambulatory Care, Outpatient or Home Care Setting a plusLicensure with the Commonwealth Care Of Massachusetts as a LPN or RN a plusUp-to-date knowledge of:
ICD-10-CM, CPT and E&M coding guidelines and Medicaid and Medicarereimbursement guidelinesUp-to-date clinical knowledge to be able to efficiently and concurrently review medical records, understandclinical picture of the patient condition, and identify opportunities for improved documentation.
Ability to create and maintain strong interpersonal relationships with the Clinical and Administrative StaffWell-developed verbal and written communication skills to effectively and professionally communicate withclinical staff about review findings associated with coding and documentationAbility to develop and deliver education programs on clinical documentation improvement for the Clinical Staff.
Knowledgeable of health care insurance claims practice and complianceFamiliarity with physician-specific regulations and policies related to documentation and codingKnowledge of Medicare Risk Adjustment Documentation with Certified Risk Adjustment Coder (CRC)certification or in process of obtaining this certificationExperienced to Proficient in Microsoft office ProductsExperienced in working with EMR's (eCW, Epic, etc.
)Ability to multi-task and function in multifaceted settingsAttention to details and with consistent and timely follow- up.
RequiredEnglish, Secondary language is not required but a plusEEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/DisabledPlease note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
Commonwealth Care Alliance is an equal opportunity employer.
Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
Recommended Skills Administration Ambulatory Care Attention To Detail Billing Cpt Coding Certified Coding Specialist Estimated Salary: $20 to $28 per hour based on qualifications.
Under the guidance of the Manager for Billing, Coding, & Provider Documentation this position will supportinternal & external clinical and operational coding initiatives at Commonwealth Care Alliance (CCA).
TheClinical Documentation Sr.
Specialist will serve as a primary resource in evaluating medical encounter notes/records housed either at CCA or at contracted primary care sites to ensure completeness, accuracy, andcompliance with the International Classification of Diseases Manual - Clinical Modification(ICD-10-CM) and the American Medical Association's Current Procedural Terminology manual (CPT).
TheCDIS will be responsible for educating and advising CCA internal departments and CCA's primary care sites inMedicaid and Medicare documentation requirements as well as guiding in the identification and application ofappropriate ICD-10 CM & CPT/HCPCS corrective coding techniques to capture CCA member's acuity/chronicdisease profile.
What You'll Be Doing:
Evaluates medical record documentation and corrective coding to optimize reimbursement and ensureadequate collection of clinical quality data; ensures diagnostic and procedural codes and other documentationaccurately reflect and support services rendered as well as data comply with legal standards and guidelines;interprets medical information such as diseases, symptoms and treatment, and diagnostic descriptions andprocedures for a given visit in order to accurately assign and sequence the correct ICD-10-CM and CPT codesand identify all appropriate codes based on CMS HCC categoriesProvides technical guidance to primary care site in identifying and resolving issues or errors, such asincomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that donot conform to approved coding principles/guidelines; educates and advises staff on proper code selection,documentation, procedures, and requirementsCPC/CCS and CRC requiredMaintains a 95% quality audit accuracy rate every monthAttends all clinical site meetings providing support & coding education as neededReviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues,trends, and changes in the laws and regulations governing medical record coding and documentationIdentify training needs, prepare training materials, and conduct education training programs related tocorrective Diagnosis & CPT documentation requirementsDevelops and updates procedure manuals to maintain standards for correct coding, minimize the risk of fraudand abuse, and optimize revenue recoveryServe as a resource for primary care site to answer questions regarding risk adjustment, corrective CPTcoding, Medicare & Medicaid coding guidelines and updatesMaintains all related CDI & Coding Credentials certifications and CEU requirementsAdditional duties as identifiedWhat We're Looking For:
RequiredAssociate's Degree or equivalent experiencePreferredBachelor's Degree --preferredRequired2-4 years experienceAssociate Degree, Bachelor's Degree or equivalent work experience with Coding and documentation reviewand ability to interact and communicate with providers in a collegial manner.
Possession of Certified Coding Specialist designation (CCS, CCS-P, CCA from AHIMA) or CertifiedProfessional Coder (CPC), and Certified Risk Adjustment Coder (CRC) from the American Association ofProfessional Coders (AAPC) is required2-3 years in a Health care setting working with codes and reviewing documentation.
Required2
years clinical experience working within a health care setting performing clinical documentation and CPT/HCPCS coding activities2
years' experience in medical coding in ambulatory Care, Outpatient or Home Care Setting a plusLicensure with the Commonwealth Care Of Massachusetts as a LPN or RN a plusUp-to-date knowledge of:
ICD-10-CM, CPT and E&M coding guidelines and Medicaid and Medicarereimbursement guidelinesUp-to-date clinical knowledge to be able to efficiently and concurrently review medical records, understandclinical picture of the patient condition, and identify opportunities for improved documentation.
Ability to create and maintain strong interpersonal relationships with the Clinical and Administrative StaffWell-developed verbal and written communication skills to effectively and professionally communicate withclinical staff about review findings associated with coding and documentationAbility to develop and deliver education programs on clinical documentation improvement for the Clinical Staff.
Knowledgeable of health care insurance claims practice and complianceFamiliarity with physician-specific regulations and policies related to documentation and codingKnowledge of Medicare Risk Adjustment Documentation with Certified Risk Adjustment Coder (CRC)certification or in process of obtaining this certificationExperienced to Proficient in Microsoft office ProductsExperienced in working with EMR's (eCW, Epic, etc.
)Ability to multi-task and function in multifaceted settingsAttention to details and with consistent and timely follow- up.
RequiredEnglish, Secondary language is not required but a plusEEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/DisabledPlease note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
Commonwealth Care Alliance is an equal opportunity employer.
Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
Recommended Skills Administration Ambulatory Care Attention To Detail Billing Cpt Coding Certified Coding Specialist Estimated Salary: $20 to $28 per hour based on qualifications.
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