This position is Hyrbid but will require travel throughout the Greater Los Angeles area on a regular basis. The Clinical Documentation Specialist works independently and is responsible for performing clinical chart reviews and pre-charting on risk adjustable patient populations. The Clinical Documentation Specialist exercises critical thinking by applying clinical knowledge to correlate relevant diagnoses for the primary care physician (PCP) to consider at the time of the face to face visit.
The Clinical Documentation Specialist will also be responsible for tracking and verifying all their findings. Leads or provides education/training to clinical care and administrative support team members regarding the clinical documentation requirements essential for risk adjustable diagnoses and their impact on reimbursement and regulatory requirements set forth by CMS and other regulatory entities. Assists in developing educational materials as needed.
Responsibilities Reviews and assesses medical charts clinically by suggesting risk adjustable diagnoses to the PCP for consideration in reflecting the true burden of illness. Supports a variety of projects as needed when reviewing related medical records for Providers with high volume or opportunity. Conducts pre-charting findings and orders prior to patient visit with PCP daily/weekly.
Reviews PCP’s documentation & coding to ensure documentation reflects the true acuity of the patient. Utilizes HCC analytics information to target populations for review based on level of opportunity Updates OPA alerts with suspected HCC opportunities based on chart review Assisting in the development of HCC educational materials Provide direct elbow support to clinicians on documentation best practices Lead HCC educational sessions with new and returning physicians Education High School Diploma/GED - minimum Bachelor's Degree Bachelor's Degree in Nursing or Health Information Management. - preferred Experience 3 years Medicare risk adjustment coding & documentation required 2 years Experience providing training information to clinical and administrative staff preferred 3 years Experience using software such as Microsoft Office including Excel and PowerPoint to develop presentations preferred 1 year Exposure to risk adjustment analytics platform(s) to gain insights into risk adjustment performance and opportunities required Licenses and Certifications Valid Clinical CA license preferred (PA, NP, LVN or RN) Registered Health Information Administrator preferred AHIMA or AAPC coding credential and/or registration (One or more of the following: CDIP, CDEO, CCS, CPC, CRC) required