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Senior Ambulatory CDI Specialist - PHSO

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Other Non-Clinical Professional
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Adventist Health System Corporate Office

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!

We are currently seeking qualified candidates for a Senior Ambulatory CDI Specialist position that will be based in our PHSO department. This position is based in Maitland, FL.

The Specialist Ambulatory CDI Senior demonstrates strong clinical knowledge and understanding of coding/Hierarchical Condition Categories (HCC)/Risk Adjustment Factor (RAF) requirements and Clinical Care Gaps to improve overall quality and completeness of clinical documentation in the patient medical record on a concurrent, and potentially a prospective and retrospective basis, using a multi-disciplinary team process. The Specialist Ambulatory CDI Senior works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement and risk adjustment factors scores. This position is responsible for understanding the clinical Care Gaps for different populations, using physicians’ education and multi-disciplinary team approach to help closing them.

Job Duties :
  • Reviews clinical documentation and coding during ambulatory encounters and possibly prospectively or retrospectively, to determine opportunities to improve physician documentation and communicates identified opportunities to the physician. Conducts timely follow-up reviews to ensure appropriate clinical documentation is recorded in patient's chart and appropriate ICD-10 codes are attached to the visit.
  • Performs concurrent medical record reviews facilitating improvement in the quality, completeness and accuracy of medical record documentation to ensure coding compliance, accurate reporting, appropriate risk scoring, and improved patient outcomes. Performs prospective and/or retrospective reviews as assigned.
  • Maintains knowledge of coding and billing rules and regulations to ensure that the documentation in the medical record supports appropriate reimbursement.
  • Participates in assuring ambulatory and payor coding/documentation compliance with Federal and State regulatory bodies.
  • Educates members of the patient care team, including medical staff, on documentation guidelines on an on-going basis.
  • Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with physicians, case management staff, nursing staff, other patient caregivers, and coding staff. With Director and Supervisor’s guidance, collaborates with coding staff to develop standard coding guidelines, policies and procedures.
  • Submits verbal, electronic or written queries as appropriate, to clinicians to ensure documentation of complete and accurate records to allow coding assignments post encounter that will accurately reflect the severity and risk of mortality of the patient population.
  • Ensures the accuracy and completeness of clinical information used for measuring and reporting physician, hospital and regulatory outcomes. Reviews data and trends to identify additional areas of opportunity. Provides input to core measure and other quality data initiatives regarding areas for investigation and education.
  • Delivers provider specific metrics ad coach providers on Gap closing opportunities as needed

KNOWLEDGE AND SKILLS REQUIRED:
  • High level of interpersonal and communication skills necessary to establish rapport with physicians and other healthcare providers.
  • Minimum MS Office (Word, Outlook, Excel and PowerPoint) knowledge
  • Regulatory background and risk adjustment/HCC knowledge (Preferred)

EDUCATION AND EXPERIENCE REQUIRED :
  • Clinical experience per licensure/certification requirements listed below
  • At least two (2) years of experience as a concurrent or retrospective documentation specialist depending on degree
  • Strong Ambulatory Background (Preferred)
  • Experience with Medicare risk adjustment, Hierarchical Condition Categories, coding, billing, auditing and various healthcare payers (Preferred)
  • Experience with Care Gaps (Preferred)

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED :
  • CDIP, CCDS or CPC (Clinical Documentation Improvement Practitioner/Certified Clinical Documentation Specialist/Certified Professional Coder) AND EITHER
  • An RN, RHIA, RHIT, MD or DO and two (2) years of experience as a concurrent or retrospective documentation specialist OR
  • A Bachelor's degree (or equivalent) in an allied health field (other than what is listed above) and three (3) years of experience as a concurrent or retrospective documentation specialist. The education component must include completed college-level course work in medical terminology and human anatomy and physiology.

Attribute
  • Business Partnering: Promotes collaboration and the sharing of ideas and perspectives with other internal functions and stakeholders
  • Develops Others: Recognizes colleagues’ strengths and development opportunities and provides them with ongoing feedback and coaching
  • Develops Self: Understands own strengths and development needs, learns from experience, and owns personal development
  • Knows the Business: Understands how the business works and can identify sources of value, efficiency, and effectiveness
  • Manages Change: Anticipates and drives change in order to meet organizational goals
  • Manages Quality and Risk: Understands and applies quality assurance and risk management procedures in all areas of work performed
  • Manages to Results: Contributes to the successful realization of goals and demonstrates accountability for goal realization
  • Subject Matter Expertise: Possesses deep knowledge and specialized skill set pertaining to the job function


If this position sounds like a great match for your skills set and experience, please apply online now!

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