- Conducts prospective and retrospective review of the medical record to ensure accurate, complete, and specific documentation that reflects the current clinical complexity of the patient
- Collaborates with Coding and Coding Education Staff to:
- Provide education to Providers and support clinical care teams on documentation, coding changes, and compliance concerns
- Monitor changes in laws, regulations, rules, and code assignments that impact documentation, reimbursement, and patient risk scores
- Provide input and valuable feedback on audit results as applicable
- Collaborates with interdisciplinary teams to assist with problem resolution, appropriate reimbursement, and systems/performance measures
- Provides consultation and education to organizational departments and committees as requested to ensure regulatory compliance and optimum reimbursement
- Develops relationships with providers and communicates guidelines and requirements of Risk Adjustment Payment System to ensure accurate coding and documentation
- Maintains knowledge of related regulations and requirements supporting ACA/Commercial Risk Adjustment Data Validation
- Completes and tracks all Patient Assessment Forms and other various projects as requested by health plans
- Current Maine RN license in good standing required
- Associates degree in Nursing or higher required; Bachelor's Degree in Nursing Preferred
- Recent clinical experience (minimum 5 years), preferably in primary care setting
- Experience with EMR, preferably eClinical Works
- Certified Risk Adjustment Coder (CRC) or ability to obtain certification within 6 months from date of hire
- 1+ years recent experience ICD-10 coding and/or 1+ years of recent Risk Adjustment / HCC Coding experience preferred
- Knowledge of HEDIS, abstraction concepts, Medicare Risk Adjustment and CMS risk adjustment guidelines, health plan terminology and concepts preferred
- Proficient with Microsoft Office products (Word, Outlook, Excel, PowerPoint) required
- The ideal candidate will: possess strong attention to detail, organizational and prioritization skills, and the ability to handle multiple tasks at the same time; flexibility and willingness to work both independently and collaboratively as part of a team; excellent oral and written communication skills, professional judgment and decision- making ability; highly developed problem solving and deductive reasoning skills; ability to meet deadlines and produce accurate work product.
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Clinical Documentation Improvement Specialist
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InterMED South Portland, United StatesState of Maine Residency is required.Essential FunctionsConducts prospective and retrospective review of the medical record to ensure accurate, complete, and specific documentation that reflects the current clinical complexity of the patientCollaborates with Coding and Coding Edu ...
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Cornwall Partnership NHS Foundation Trust Falmouth, United States PermanentJob summary · This is an exciting role to work within the Home First Central Area, supporting the continued development of the reablement service. You will be responsible for supporting the Team Lead with the day-to-day line management of the Community Support Workers (CSWs). · ...
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Elevance Health South Portland, United States Full timeJob Description · : SCA Data Specialist · Locations: Elevance Health supports a hybrid workplace model with Pulse Point sites (major office) used for collaboration, community, and connection. This position will be primarily virtual, however will be based within 50 miles of an ...
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Charlie Burnham Energy Service, Inc. South Portland, United StatesDead River Company is seeking a Field Service Business Training Specialist to join our team. · This position is based out of South Portland, ME. · Position Summary: · The Field Service Training Specialist is responsible for providing a consistent training experience for all new ...
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EHS Manager
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Aledade, Inc. South Portland, United StatesJoin Aledade as a · Practice Transformation Specialist (PTS) · and personally make an impact on patient care. As a PTS you will make frequent visits to your assigned group of practices in order to assist the physicians and staff with practice transformation plans to shift into ...
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Clinical Documentation Improvement Specialist - South Portland, United States - InterMed, P.A.
Description
Job Description
Job DescriptionState of Maine Residency is required.Essential FunctionsInterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and/or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.
