POSITION SUMMARY:
The Outpatient Clinical Documentation Integrity (CDI) Specialist is a key figure in enhancing patient care. Serving as a bridge between providers, coders, and the revenue cycle, you will use your clinical knowledge, national coding, and compliance guidelines to clarify at-risk or incomplete documentation and ensure complete and accurate claim submissions. Your responsibility for reviewing patient medical records in the clinic setting to capture an accurate representation of risk adjustment and facilitate proper coding is crucial. It directly influences the quality of care our patients receive and the accuracy of our clinical practices. This Outpatient CDI role is not just a job but a dedication to the patients attributed to RIPCPC.
ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation.
- Possess expertise in how proper provider documentation drives the coding accuracy for complexity and medical necessity, improving the quality of care and patient outcomes for outpatient services and associated risk adjustment.
- Demonstrate ability to build strong working relationships with clinicians, administrators, and revenue cycle colleagues.
- Leverage strong communication skills to bridge interrelated concepts, business functions, and processes to deliver results through an Outpatient CDI program.
- Understand various payment structures, fee schedules, reimbursement methodologies in the outpatient setting and physician encounters, and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet reporting requirements.
- Utilize EHR to prioritize encounters for review and accurately enter data in an Excel spreadsheet to ensure the integrity of tracked data for reporting key performance indicators, including productivity, physician engagement, and potential financial impact.
- Knowledge of, but not limited to, current coding guidelines and methodologies: HCCs, ICD-10-CM coding guidelines, Office of Inspector General (OIG), and other government mandates
- Extensive knowledge of medical terminology, anatomy, pathophysiology, pharmacology, and ancillary test results
- Possess strong organization and analytical thinking skills and is detail-oriented
Additional Information:
The position serves both employed and independent providers and clinics in RIPCPC clinics.
Access to and works with sensitive and confidential information.
Exhibit a comprehensive understanding of healthcare regulatory and compliance (e.g., HIPAA) information. Skilled in the application of policies and procedures. Knowledge of business office standards and recommended practices.
This Position is 100% Remote – *Open to candidates in Rhode Island, Massachusetts, Connecticut, Texas, or Florida.*
Knowledge, Skills, and Abilities:
The requirements below represent the required knowledge, skills, and abilities.
- Education: Preferred Risk Adjustment Coder and/or the certifications listed below.
- Experience: A minimum of 3 years of ambulatory risk adjustment coding experience
License or Certification:
A Certified Risk Adjusted Coder (CRC) is preferred. Certified Professional Coder (CPC) and Certified Coding Specialist (CCS) certifications will also be considered.
Skills and Abilities:
This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients’ acute and chronic conditions
- ICD-10-CM Coding experience
- Ability to work independently with minimal supervision after training
- Knowledge of HCCs and risk models
- Proficient critical thinking, reasoning, and deduction to draw accurate clinical conclusions
- Ability to navigate various electronic health records and utilize AI/NLP technologies
- Positive attitude and team player
- Ability to collaborate with providers
Physical and Mental Demands:
The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job responsibilities.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. The repetitive motion of the upper body required for extended use of a computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Rhode Island Primary Care Physicians Corporation Overview:
Rhode Island Primary Care Physicians Corporation (RIPCPC) is a multi-specialty Independent Practice Association (IPA) of physicians located throughout the State of Rhode Island. RIPCPC, originally formed in 1994, currently represents over? 150 primary care physicians (PCPs) from family practice, internal medicine, and pediatric medicine. The IPA also represents over 200 specialty-care member physicians which include behavioral health, optometry and ophthalmology, gastroenterology, and cardiology. RIPCPC delivers support services that are essential to providing high quality, cost-effective medicine to their patients, while also preserving community-based practices. Our PCPs provide care to over 150,000 Rhode Islanders.
Rhode Island Primary Care Physicians Corporation is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Job Type: Full-time
Pay: $63,000.00 – $68,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Professional development assistance
- Retirement plan
- Vision insurance
Schedule:
- Monday to Friday
Application Question(s):
- This position is fully remote, but limited to a certain catchment area: Do you reside in Rhode Island, Massachusetts, Connecticut, Texas, or Florida?
Work Location: Remote