Clinical Documentation Integrity Specialist - Remote, United States
21 hours ago
Job description
firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health.firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI.
We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job—it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun.
The Clinical Documentation Integrity Specialist (CDIS) is a key member of firsthand's clinical documentation team. We are looking for a scrappy, detail-obsessed individual who will ensure accurate, comprehensive, and timely clinical documentation. The CDIS will enable the best care possible for our individuals by empowering: our care teams to plan appropriate care, our support teams to identify potential population health interventions, and more.
This is a full time position. The expected workload is 40 hours per week, with flexible scheduling available in the Eastern, Central, and Mountain time zones.
As a CDIS, you will:
- Perform prospective, retrospective, and concurrent coding reviews based on evaluations of prior visit documentation, lab results, images, external medical records, payer claims data, and more
- Support pre-visit planning by communicating to firsthand providers individuals' potential chronic conditions and care gaps with robust and appropriate evidence
- Ensure accurate, timely, and comprehensive clinical documentation to support code capture, including querying providers when these clinical documentation standards are not met
- Support medical records requests when providers require additional information prior to addressing and diagnosing potential conditions
- Work with team leadership to identify chronic condition prevalence trends by individuals' demographics; identify and execute potential interventions, e.g., ongoing education to firsthand providers and the CDI team, ongoing quarterly retrospective reviews of unaddressed suspects
Minimum Qualifications:
- Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) from AAPC in good standing is required
- Minimum of 5 years of risk adjustment-focused medical record review and ICD-10 coding experience, specifically using the Medicare HCC model, in multiple settings (e.g., inpatient, outpatient) Fluent knowledge of ICD-10 CM Official Guidelines for Coding and Reporting, and AHA/AMA/CMS coding resources, to support audit findings
- Ability to gain proficiency in and apply productivity tools, such as spreadsheets, Google Suite, and EHR systems
- Excellent written and verbal communication skills, especially to maintain working relationships with firsthand providers (APNs, NPs), other CDISs, Medical Records Specialists, and others
- Proven experience working remotely
- Alignment to firsthand's mission, vision and values: Demonstrate respect, dignity, empathy, and professional conduct to both individuals that firsthand serves and firsthand team members
Competencies:
- Demonstrate mastery of the Medicare HCC model, clinical coding guidelines/methodologies, and AHIMA/ACDIS ethical standards of coding; self-motivated to stay abreast of CMS rules and incorporate those changes into daily work
- Proficiency in tracking down, leveraging, and reviewing high volumes of internal and external data (e.g., medical records) to support pre-visit planning and appropriate code capture
- Self-starter with a high degree of drive, initiative, and follow through; comfortable and motivated to work in a fast-paced, ever-changing environment with a passion for problem solving
- Exceptional interpersonal, written and verbal communication skills; proven ability to collaborate across multiple teams and engage in multiple perspectives to work toward a common goal
- Query providers in an ethical manner and track compliance
- Develop CDI policies and procedures to include query process, education and training, and performance tracking
- Bonus but not necessary: familiarity with Medicaid risk models, such as CDPS or ACG
Base salary range:
$70,000 - $80,000 USD
We firmly believe that great candidates for this role may not meet 100% of the criteria listed in this posting. We encourage you to apply anyway - we look forward to begin getting to know you.
Benefits
For full-time employees, our compensation package includes base, equity (or a special incentive program for clinical roles) and performance bonus potential. Our benefits include physical and mental health, dental, vision, 401(k) with a match, 16 weeks parental leave for either parent, 15 days/year vacation in your first year (this increases to 20 days/year in your second year and beyond), and a supportive and inclusive culture.
Employment with firsthand is contingent upon attesting to medical clearance requirements, which include, but may not be limited to: evidence of vaccination for/immunity to COVID-19, Hepatitis B, Influenza, MMR, Chickenpox, Tetanus and Diphtheria. All employees of firsthand are required to receive these vaccinations on a cadence/frequency as advised by the CDC, whereas not otherwise prohibited by state law.
New hires may submit for consideration a request to be exempted from these requirements (based on a valid religious or medical reason) via forms provided by firsthand. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed.
Unfortunately, we are not able to offer sponsorship at this time.
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